Bipolar Treatments- AEDs Used Flashcards
AEDs used in BPD
VPA, LTG, CBZ
AEDs are most likely used in patients with what PMH?
Substance abuse history or active misuse- it can result in additive hepatotoxicity and increased suicide risk
When to use VPA in BPD
Used alone or in combo with other drugs (Li, CBZ, APS) for acute treatment of manic or mixed episodes
VPA BBW
Pancreatitis and/or liver toxicity, hepatotoxicity, urea disorders
What should you have patients report (in relation to the VPA BBW)
Flu-like symptoms, GI pain, yellowing of skin, dark urine
VPA side effects that are dose-related
GI upset, tremor, sedation, alopecia
How to manage VPA dose-related complications
GI symptoms can go away on their own, but try taking it with food, give ER formulations, and/or move to HS dosing to reduce sedation. Alopecia is reversible if you switch to another med
Other VPA side effects (the ones that aren’t dose-related)
Prolonged bleeding, weight gain, hyperammonemia
VPA monitoring
CBC with diff
Baseline LFTs
Baseline renal function (Screen and BUN)
Serum drug concentrations 3-5 days after initiation or when stable dose established
Weight
Ammonia if hyperammonemia is suspected
When to use LTG in BPD
Alone or in combo with other drugs for long-term maintenance treatment of BP-I
VPA vs. LTG for BP depression: which one’s better?
LTG
LTG dosing: what’s the caveat?
It needs slow titration and missing doses require re-titration
What happens to the dose of LTG when combining with VPA?
The dose gets cut in half!
LTG’s worst side effect
SJS!!!!!!!!!
Other LTG side effects (besides SJS)
Aseptic meningitis, prodrome chills, sore throat, fever, increased risk of heart arrhythmias in patients with heart disease, abnormal ECG, chest pain, loss of consciousness, cardiac arrest
LTG monitoring
CBC with diff
LFTs
Renal function (SCr and BUN)
Weight
Rash development (SJS)
Only CBZ formulation used for BPD
Equetro (CBZ ER)
When to use CBZ in BPD
Used alone or in combination with other drugs (Li, VPA, APS) for acute and long-term maintenance treatment of mania or mixed episodes for BP-I
(Not supported for maintenance use and it’s off-label???)
What patients should you use CBZ in?
Reserve CBZ for patients who aren’t able to tolerate or have an inadequate response to PTG or VPA
CBZ DDIs
Strong inducer of many CYP enzymes and can affect the metabolism of SSRIs, TCAs, MAOIs, and other mood stabilizers
That one weird feature about CBZ
It auto induces its own metabolism
CBZ side effects
Neutropenia, agranulocytosis, BONE MARROW SUPPRESSION, leukopenia, hematologic disease, SJS/TEN risk, hyponatremia, increased ADH release, porphyria
Because of CBZ’s risk of leukopenia, what’s CI’ed?
MAOI therapy, nefazodone, lurasidone
How can you find out if a patient is at risk of getting SJS/TEN from CBZ?
Genomic testing for HLA-B*15:02 – if the test is positive, don’t give them CBZ
CBZ monitoring
CBC with diff
ECG
LFTs
TSH
renal function
serum electrolytes
weight
HLA-B*1502
rash development
