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HLSC 220 - Pharmacotherapeutics for Healthcare Professionals > Chapter 36 - Drugs for Bipolar Disorder > Flashcards

Chapter 36 - Drugs for Bipolar Disorder Flashcards

1
Q

Are there gender differences in the stats of bipolar disorder?

A

no

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2
Q

What is bipolar disorder?

A

a cyclic disorder involving fluctuations in mood between mania and depression

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3
Q

What are the anxious distress symptoms of bipolar disorder?

A

-tension
-restlessness
-difficulty concentration
-constant worry
-feeling out of control

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4
Q

What are the mixed features of bipolar disorder?

A

meeting criteria for manic or hypomanic episode but having depression symptoms at the same time

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5
Q

What are the melancholic features of bipolar disorder?

A

loss of pleasure in all or most activities, not feeling better when something good happens

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6
Q

What are the atypical features of bipolar disorder?

A

-symptoms not typical of a depressive episode
-improved mood when something good happens

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7
Q

Peripartum Onset

A

bipolar symptoms that occur during pregnancy or in the four weeks after delivery

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8
Q

Seasonal Pattern

A

lifetime pattern of manic, hypomanic, or depression that change with seasons

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9
Q

Rapid Cycling

A

having four+ mood swing episodes in a single year with periods of remission in between

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10
Q

Psychosis

A

severe episode of mania or depression that results in detachment from reality and includes delusions or hallucinations

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11
Q

Catatonia

A

not reacting to your environment, holding your body in an unusual position, not speaking, or mimicking speech or movement

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12
Q

Bipolar I Disorder

A

-have at least one manic episode
-episode is followed by hypomanic or major depressive episode
-mania causes psychosis

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13
Q

Bipolar II Disorder

A

-have at least on major depressive episode lasting at least 2 weeks
-at least one hypomanic episode lasting at least 4 days
-NEVER HAD A MANIC OR MIXED EPISODE

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14
Q

Cyclothymic Disorder

A

-at least 2 years (1 year in children) of hypomanic symptoms (not episode) and periods of depressive symptoms (not episode)

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15
Q

Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, and risperidone alone or in combo are first-line treatments for ______ _______ (CANMAT).

A

acute mania

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16
Q

Quetiapine, lurasidone plue lithium or divalproex, lamotrigine, lurasidone are all first line options for ________ ___ ________ (CANMAT).

A

bipolar I depression

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17
Q

What are some examples of mood stabilizers?

A

-lithium
-divalproex sodium
-carbamazepine

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18
Q

What are mood stabilizers used for?

A

-relieving symptoms during manic and depressive episodes
-preventing recurrence of episodes
-do not worsen symptoms or accelerate cycling

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19
Q

When are antipsychotics given for bipolar disorder?

A

severe manic episodes

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20
Q

When are antidepressants given for bipolar disorder?

A

depressive episodes

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21
Q

Lithium + Valproate + Antipsychotic are used for…

A

short-term therapy of MANIC episodes

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22
Q

Lithium or Valproate, Bupropion, Venlafaxine, or a SSRI, and certain antipsychotics are used for…

A

short-term therapy of DEPRESSIVE episodes

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23
Q

What lifestyle changes are important for bipolar disorder?

A

-avoid substance use
-sleep
-monitor mood
-stress reduction
-regular activity

24
Q

What are other nondrug therapies for bipolar disorder?

A

-psychotherapy
-ECT (not 1st choice)

25
Q

What drug class is lithium?

A

mood stabilizer

26
Q

How does Lithium act (supposedly)?

A

-alter ion distribution
-alter synthesis and release of 5-HT, DA, and NE
-affects second messengers (cAMP)
-alters glutamate uptake and release
-block 5-HT binding
-inhibit glycogen synthesis

27
Q

Lithium can be used as an adjunct drug for?

A

-schizophrenia
-depression

28
Q

Lithium has a ______ half-life

A

short

29
Q

Lithium excretion is ________ when sodium levels are low (and vv)

A

reduced

30
Q

Lithium has a ________ therapeutic index

A

narrow

31
Q

What is the maintenance lithium plasma level?

A

0.6-1.0 mmol/L

32
Q

What is the acute lithium plasma level?

A

0.8-1.2 mmol/L

33
Q

What is the elderly lithium plasma level?

A

0.4-0.7 mmol/L

34
Q

What lab values MUST be done before starting lithium?

A

-electrolytes
-renal and hepatic function
-ECG
-thyroid function
-pregnancy test

35
Q

What are the AEs of lithium in a therapeutic level?

A

-N&V
-diarrhea
-hand tremor
-polyuria
-thirst
-renal toxicity
-goiter
-hypothyroidism
-teratogenic
-alopecia
-acne
-weight gain

36
Q

What are the symptoms of lithium toxicity in the 1.5-2.0 mmol/L range?

A

-drowsy
-ataxia
-tremor
-slurred speech

37
Q

What are the symptoms of lithium toxicity in the >2.0 mmol/L range?

A

-arrythmias
-seizures
-bradycardia
-myocarditis
-coma
-death

38
Q

What is the antidote for lithium toxicity?

A

none.

39
Q

What does Lithium interact with?

A

-diuretics
-NSAIDs
-ACEIs
-ARBs
-caffeine
-sodium

40
Q

Therapeutic effects of lithium can take up to ___ weeks.

A

3

41
Q

How do you minimize GI effects of lithium?

A

give with food

42
Q

Antiepileptic drugs can also be used as…

A

mood stabilizers

43
Q

What is Divalproex (Valproic acid) used for?

A

-bipolar disorders
-seizure disorders
-migraines

44
Q

What does Divalproex interact with?

A

lamotrigine

45
Q

Is Divalproex safe during pregnancy?

A

no - teratogenic

46
Q

How is carbamazepine (Tegretol) administered?

A

-chewtab
-tablet
-suspension
-CR

47
Q

What is a major AE of carbamazepine and lamotrigine?

A

Stevens-Johnson syndrome

48
Q

What is carbamazepine used for?

A

-seizures
-bipolar disorder
-trigeminal neuralgia

49
Q

The dose of Lamotrigine should be reduced with simultaneous use of ___________.

A

Divalproex

50
Q

What is Lamotrigine used for?

A

long-term maintenance of bipolar disorder

51
Q

What is Gabapentin used for?

A

-treatment of neuropathic pain
-AED
-anxiety

52
Q

What are the adverse effects of Gabapentin?

A

-somnolence
-weight gain
-blurred vision

53
Q

What are the adverse effects of Topirimate?

A

-cognitive dysfunction
-paresthesia
-kidney stones
-less sweating
-weight loss

54
Q

Topiramate interacts with ____

A

OC’s

55
Q

What antipsychotics are approved for bipolar disorder?

A

-olanzapine
-quetiapine (seroquel)
-risperidone
-aripiprazole
-ziprasidone
-lurasidone (depression)
-cariprazine (mania)

56
Q

Patients on Lithium must maintain a constant __________ intake

A

sodium

HLSC 220 - Pharmacotherapeutics for Healthcare Professionals (18 decks)

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