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BPD, Anxiety, Parkinson's, Dementia > BPD > Flashcards

BPD Flashcards

1
Q

What drugs are not recommended for Acute Mania

A

Gabapentin, lamotrigine, topiramate, verapamil, tiagabine, combos (risperidone + CBZ & olanzapine + CBZ)

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2
Q

What drugs are not recommended Depressive episodes

A

Gabapentin, Abilify, ziprasidone, combos (adjunctive ziprasidone, adjunctive keppra)

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3
Q

What drugs are not recommended for maintenance therapy

A

Gabapentin, topiramate, or antidepressants, adjunct: fluphenthixol

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4
Q

Which drugs are FDA approved for acute major depressive episodes

A

Lithium, lamotrigine, quetiapine

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5
Q

Which drugs are used for agitation

A

Abilify, lorazepam, loxapine, olanzapine

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6
Q

LAI’s approved for BPD

A

Abilify Maintena and Risperdol Consta

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7
Q

What drugs are FDA approved for acute mania and mixed episodes

A

Lithium, VPA, CBZ IR/ER, Abilify, asenapine, cariprazine, olanzapine, quetiapine, risperidone, ziprasidone

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8
Q

What drugs are FDA approved for maintenance of BPD

A

Lithium, Lamotrigine, Abilify, olanzapine, quetiapine, risperidone, ziprasidone (adjunct Li/VPA)

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9
Q

What drugs are FDA approved for acute depression monotherapy

A

cariprazine, lurasidone, olanzapine (w/ Prozac), quetiapine

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10
Q

Lithium interactions

A

-NSAIDs: inc levels of Li
-ACE/ARB: inc levels of Li
-Diuretics: Li levels inc with thiazide use and dec with mannitol use
-Methylxanthines (caffeine): Li levels dec
-Clozapine (blood dyscrasia)

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11
Q

Lithium AE

A

-Polydipsia, polyuria w/ or w/o nephrogenic diabetes insipidous (NDI)
-May unmask Brugada syndrome

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12
Q

Lithium CI

A

-Breastfeeding (also crosses placenta, floppy baby syndrome), severe renal or cardiac disease (or w/ dehydration or Na depletion)
-Avoid drugs/things that effect renal function (NSAIDs, ACE/ARB, Diuretics, CCB, ECT)
-ECT: d/c 2 days before and after procedure

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13
Q

Lithium monitoring

A

-Renal and thyroid function
-Eliminated entirely, no hepatic metabolism

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14
Q

Lithium SE

A

-Dose related
-Maintain at lowest effective dose
-1 daily dose at bedtime
-Take with food
-Use liquid formulation if pt has diarrhea
-Muscle weakness/lethargy (tremor)
-If tremor occurs switch to long acting drug, dec dose, or add a beta blocker (propranolol)

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15
Q

Normal Lithium serum concentration

A

-0.6-1.2 mEq/L
-toxic: >1.5 mEq/L

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16
Q

Lithium levels

A

8 hours after dose (trough), 5-7 days after initiation (steady state)

17
Q

Anticonvulsants FDA approved for BPD

A

VPA, Lamotrigine, CBZ ER (equetro only)

18
Q

VPA dose related problems

A

-GI, tremor, sedation
-Give with food, lower doses, or ER version for GI effects
-Beta blockers reduce tremor
-Alopecia (up to 25% of pt, reversible)

19
Q

VPA ER

A

lower bioavailability, more may be needed (required for seizures)

20
Q

VPA prolonged bleeding

A

-Elderly inc risk
-Thrombocytopenia

21
Q

VPA BBW

A

Pancreatitis &/or liver toxicity, urea disorders

22
Q

VPA hyperammonemia

A

treat with lactulose if severe

23
Q

Lamotrigine

A

-slow titration to prevent SJS
-preferred over VPA for bipolar depression
-not effective for acute depression
-must use 1/2 the dose if combined with VPA
-Interruption >48 hours requires retitration
-Aseptic meningitis, prodrome chills, sore throat, fever
-Lamictal/VPA = less drowsiness than others

24
Q

CBZ CI

A

-MAOI therapy, nefazodone, lurasidone
-porphyria, agranulocytosis, Asian HLA-B 1502 (10 x risk SJS/TEN)
-Inc ADH release (SIADH)
-bone marrow suppression
-Hematologic disease (TCA/CBZ hypersensitivity)
-Stronger inducer of many CYP enzymes and can effect metabolism of SSRIs, TCAs, MAOIs, and other mood stabilizers
-VPA can inc concentration

25
Q

BZD

A

-High potency agents: clonazepam and lorazepam used for anxiety, panic, agitation drug acute mania
-Short term use
-Avoid in sub abuse pt

26
Q

CCB

A

-Not FDA approved
-verapamil, nimodipine
-interact with Li

27
Q

Lybalvi

A

-BP-1
-Acute treatment of manic or mixed episodes, monotherpay or adjunct to Li or VPA
-CI: opioid use

28
Q

Drugs in pregnancy

A

-Divalproex: neural tube defects & irreversible cognitive impairment (use folic acid to mitigate NT defects)
-CBZ: inc risk of spina bifida
-Lamotrigine: Lower levels during pregnancy, cleft palate reported
Li: abnormal tricuspid valve, inc doses needed during pregnancy

BPD, Anxiety, Parkinson's, Dementia (4 decks)

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