Chapter 36 - Drugs for Bipolar Disorder Flashcards
Are there gender differences in the stats of bipolar disorder?
no
What is bipolar disorder?
a cyclic disorder involving fluctuations in mood between mania and depression
What are the anxious distress symptoms of bipolar disorder?
-tension
-restlessness
-difficulty concentration
-constant worry
-feeling out of control
What are the mixed features of bipolar disorder?
meeting criteria for manic or hypomanic episode but having depression symptoms at the same time
What are the melancholic features of bipolar disorder?
loss of pleasure in all or most activities, not feeling better when something good happens
What are the atypical features of bipolar disorder?
-symptoms not typical of a depressive episode
-improved mood when something good happens
Peripartum Onset
bipolar symptoms that occur during pregnancy or in the four weeks after delivery
Seasonal Pattern
lifetime pattern of manic, hypomanic, or depression that change with seasons
Rapid Cycling
having four+ mood swing episodes in a single year with periods of remission in between
Psychosis
severe episode of mania or depression that results in detachment from reality and includes delusions or hallucinations
Catatonia
not reacting to your environment, holding your body in an unusual position, not speaking, or mimicking speech or movement
Bipolar I Disorder
-have at least one manic episode
-episode is followed by hypomanic or major depressive episode
-mania causes psychosis
Bipolar II Disorder
-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
Cyclothymic Disorder
-at least 2 years (1 year in children) of hypomanic symptoms (not episode) and periods of depressive symptoms (not episode)
Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, and risperidone alone or in combo are first-line treatments for ______ _______ (CANMAT).
acute mania
Quetiapine, lurasidone plue lithium or divalproex, lamotrigine, lurasidone are all first line options for ________ ___ ________ (CANMAT).
bipolar I depression
What are some examples of mood stabilizers?
-lithium
-divalproex sodium
-carbamazepine
What are mood stabilizers used for?
-relieving symptoms during manic and depressive episodes
-preventing recurrence of episodes
-do not worsen symptoms or accelerate cycling
When are antipsychotics given for bipolar disorder?
severe manic episodes
When are antidepressants given for bipolar disorder?
depressive episodes
Lithium + Valproate + Antipsychotic are used for…
short-term therapy of MANIC episodes
Lithium or Valproate, Bupropion, Venlafaxine, or a SSRI, and certain antipsychotics are used for…
short-term therapy of DEPRESSIVE episodes
What lifestyle changes are important for bipolar disorder?
-avoid substance use
-sleep
-monitor mood
-stress reduction
-regular activity
What are other nondrug therapies for bipolar disorder?
-psychotherapy
-ECT (not 1st choice)
What drug class is lithium?
mood stabilizer
How does Lithium act (supposedly)?
-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
Lithium can be used as an adjunct drug for?
-schizophrenia
-depression
Lithium has a ______ half-life
short
Lithium excretion is ________ when sodium levels are low (and vv)
reduced
Lithium has a ________ therapeutic index
narrow
What is the maintenance lithium plasma level?
0.6-1.0 mmol/L
What is the acute lithium plasma level?
0.8-1.2 mmol/L
What is the elderly lithium plasma level?
0.4-0.7 mmol/L
What lab values MUST be done before starting lithium?
-electrolytes
-renal and hepatic function
-ECG
-thyroid function
-pregnancy test
What are the AEs of lithium in a therapeutic level?
-N&V
-diarrhea
-hand tremor
-polyuria
-thirst
-renal toxicity
-goiter
-hypothyroidism
-teratogenic
-alopecia
-acne
-weight gain
What are the symptoms of lithium toxicity in the 1.5-2.0 mmol/L range?
-drowsy
-ataxia
-tremor
-slurred speech
What are the symptoms of lithium toxicity in the >2.0 mmol/L range?
-arrythmias
-seizures
-bradycardia
-myocarditis
-coma
-death
What is the antidote for lithium toxicity?
none.
What does Lithium interact with?
-diuretics
-NSAIDs
-ACEIs
-ARBs
-caffeine
-sodium
Therapeutic effects of lithium can take up to ___ weeks.
3
How do you minimize GI effects of lithium?
give with food
Antiepileptic drugs can also be used as…
mood stabilizers
What is Divalproex (Valproic acid) used for?
-bipolar disorders
-seizure disorders
-migraines
What does Divalproex interact with?
lamotrigine
Is Divalproex safe during pregnancy?
no - teratogenic
How is carbamazepine (Tegretol) administered?
-chewtab
-tablet
-suspension
-CR
What is a major AE of carbamazepine and lamotrigine?
Stevens-Johnson syndrome
What is carbamazepine used for?
-seizures
-bipolar disorder
-trigeminal neuralgia
The dose of Lamotrigine should be reduced with simultaneous use of ___________.
Divalproex
What is Lamotrigine used for?
long-term maintenance of bipolar disorder
What is Gabapentin used for?
-treatment of neuropathic pain
-AED
-anxiety
What are the adverse effects of Gabapentin?
-somnolence
-weight gain
-blurred vision
What are the adverse effects of Topirimate?
-cognitive dysfunction
-paresthesia
-kidney stones
-less sweating
-weight loss
Topiramate interacts with ____
OC’s
What antipsychotics are approved for bipolar disorder?
-olanzapine
-quetiapine (seroquel)
-risperidone
-aripiprazole
-ziprasidone
-lurasidone (depression)
-cariprazine (mania)
Patients on Lithium must maintain a constant __________ intake
sodium
