Block 3 Flashcards
DSM-5 Criteria Bipolar I vs II
Which one has manic episodes?
I
DSM-5 Criteria Bipolar I vs II
Which one sometimes requires hospitilizations?
II
I always requires hospitalization
DSM-5 Criteria Bipolar I vs II
Which one must last for 4 consecutive days to be diagnosed?
II
DSM-5 Criteria Bipolar I vs II
Which one has hypomanic episodes?
II
DSM-5 Criteria Bipolar I vs II
Which one requires the episode to last for 1 week and being present most of those days?
I
What must occur for a cyclothymic disorder diagnosis?
Fluctuation between subsyndromal depression and hypomanic episodes
2 yrs for adults
1 yr for younger peeps
What is a mixed condition for bipolar?
Major depressive episode + manic episode almost daily for a week
Requires hospitalization
What is a rapid cycling condition for bipolar?
> 4 major depressive OR manic episodes in 12 months
Requires hospitalization
(T/F)
AD may trigger manic/hypomanic episodes
True
FDA approved agents for acute mania?
LARVA COZ Q
Lithium Aripiprazole Risperidone Valproate Asenapine
Carbamazepine
Olanzapine
Ziprasidone
Quetiapine
FDA approved agents for maintenance of bipolar?
ALDOL
Aripiprazole Lithium Divalproex Olanzapine Lamotrigine
FDA approved agents for bipolar depression?
Quetiapine + Lurasidone
Labs + Lithium?
PT BEER
Pregnancy (teratogenic
Thyroid
Blood (increase WBC)
EKG
Electrolytes (decreases sodium)
Renal (excreted)
Serum levels of lithium of acute mania and for maintenance?
Acute = 0.8 to 1.2
Maintenance = 0.6-1.0
Draw lvls 12hrs after last dose
Lithium + toxicity levels?
- 5 to 2.0 = N/V/D, ataxia, , lethargy, drowsiness
- 0 to 2.5 = anorexia, delirium, stubor, ECG changes
> 2.5 = seizures, renal damage, oliguria
Which Rx will increase concentration of lithium?
Thiazides, NSAIDs and ACE/ARBs
How do thiazides increase lithium concentration?
Sodium depletion results in increases proximal reabsorption of sodium and lithium
How do NSAIDs increase lithium concentration?
Enhanced reabsorption of sodium and lithium by inhibition of prostaglandin synthesis
How do ACE/ARBs increase lithium concentration?
Reduced GFR results in reduced lithium elimination
Which genes are associated w/ increased % of ADHD?
Dopamine transporters and receptors, SNAP25 and COMT genes
Environmental factors of ADHA?
FAS, lead poison, meningitis
Obstetric adversity, maternal smoking, adverse parent-child relationships
What are the neurotransmitters involved for ADHD?
DA and NE
Defect in receptor D4 (DRD4) receptor gene
Overexpression of DAT-1
DSM-5 Criteria for ADHD?
Must be present for ≥6 months
17+ yo = ≥5 symptoms
16 and below = ≥6 symptoms
Symptoms had to be present prior to age 12
Present in ≥2 settings
Most cases of ADHD are found in what age group?
School age; 6-11, realized from 6-9
Oppositional defiant disorder DSM 5 critera?
4 sx over 6 months (angry, argues, refuses to comply)
<5 yo = most days
>5 yo = once weekly
Conduct disorder DSM 5 criteria?
3 sx in the past 12 month but 1 in the past 6 months (bullies, fights, cruel to animals/humans, theft, property destruction)
Childhood onset <10
Adolescent >10yo
What are the brain regions involved in ADHD?
Prefrontal cortex + connection to basal ganglia and cerebellum
Specific NE receptors involved in ADHD
alpha 2A improves ADHD
alpha 1 impairs
Beta adrenoreceptors impair
What are the SNRIs used for ADHD?
Atomoxetine
What are the alpha 2 adrenergic agonists used for ADHD?
Clonidine + Guanfacine
What are the NDRIs used for ADHD?
Methylphenidate
Dexmethylphenidate
Amphetamines
Dextroamphetamines
Lisdexamfetamine
Bupropion
Methylphenidate formulations
Tablets, chewables, liquid = short acting (more flexibility, but can have peak/trough effects that might be uncomfortable)
Wax matrix tablets = intermediate (causes inconsistent release of Rx)
Osmotic release oral system = long-acting
Methylphenidate w/ food increases (Cmax/Tmax)
Cmax
(d/l) methylphenidate is more bioavailable
D
(T/F)
Methylphenidate has extensive first-pass metabolism
True
General structure of amphetamine
Ring with a basic carbon skeleton with a methyl group and amine
SAR of amphetamines?
Amine = primary is more potent than tertiary except in methamphetamines
Demethylation lowers lipophilicity and increased metabolism (S isomer more potent like in dextroamphetamines)
Adding groups to ring reduces CNS stimulation
Metabolism of amphetamines and urine?
Most are excreted unchanged
Lisdexamfetamine info?
Prodrug, needs to be hydrolyzed to form d-amphetamine
Stimulant AE?
Reduced appetite and weight loss
Insomnia, irritability, psychosis, rebound sx, and even sudden cardiac death
Bupropion vs other stimulants
Efficacy
Equal compared to methylphenidate
Bupropion vs other stimulants
AE?
Lower prevalence of appetite suppression and weight loss, but risk of seizure exists
Atomoxetine vs other stimulants
Efficacy
Less efficacious than methylphenidate OROS and has slower onset (2-4wks) vs stimulants 1-2hrs
Atomoxetine AE?
Liver injury and new-onset suicidality
Sexual AE too
More sedation vs stimulants
Clonidine vs Guanfacine, which one is more selective for alpha 2?
Guanfacine
Clonidine activates both alpha 1 and 2
When starting rx for ADHD, what should adults vs children start off?
Adults = amphetamines
Children = methylphenidates
Swap if they done work
Just know that in vyvanse, it doesnt have a dose-dependent effect but rather a dose dependent AE profile
k
Stimulant safety issues?
Psychiatric (just decrease dose)
CV risk
Growth
DI with atomoxetine?
CYP2D6 inhibitors and increased AUC with PM of CYP2D6
Which alpha 2 agonist for ADHD is affected by high fat meals?
Guanfacine (increases concentration)
What is pica?
Eat nonfood >1 month
What is rumination?
Regurgitation of food >1 month
DSM-5 Anorexia nervosa
Cant maintain >85% normal body weight or BMI >17.5
Anorexia nervosa types?
Restricting: lasts 3 months, has not engaged in binge eating or purging
Binge-eating/purging type: last 3 months
DSM-5 bulimia nervosa
Binges weekly for 3 months
vs binge-eating disorder which just requires once weekly for 3 months
What is the most common AE of AN and BN?
Cardiac complications
CV collapse due to refeeding syndrome
Prognosis of AN?
Most will reach remission, but 20% will remain chronically ill even if they reach a normal weight
2-4% of those will even die due to cardiac arrest or suicide
Considerations for hospitalizations for ppl with eating disorders?
BMI<12
Nonresponsive to outpatient tx after 3-4 months
Nonpharm Tx for AN?
Cognitive behavioral therapy for 6 months minimum
SLOW refeeding usually with liquids
Controlled wt gain (2-3lbs/wk)
Add 3500-7000 calories/week
Pharm Tx for AN?
No role for antidepressants in acute Tx
If used, SSRIs are preferred due to AE profile; Fluoxetine is the most widely studied one
Smaller study showed Olanzapine with positive results (but not FDA approved)
Works with BN too
What rx is used for binge eating disorder?
Lisdexamfetamine 50 and 70mg, NOT 30!!! (only one that is FDA approved)
SSRIs, Atomoxetine, venlafaxine
Topiramate, zonisamide, and orlistat
What are the environmental etiologies of alzheimer’s disease?
Increased age (#1 factor)
Decreased reserve capacity of brain
Head injury
Increased risk for vascular diseases