Drug Therapy of Bipolar Disorder

Question 1

Describe the symptoms and treatments of acute mania.

Answer 1

symp: excitement, grandiosity, impulsivity, dis-inhibition, reduced sleep, delusions, hyperactivity, hyper-sexuality, cognitive impairment and sometimes psychotic symptoms

1st line treatment with lithium, valproic acid, possibly other antipsychotics (olanzapine, quetiaapine, risperiadone, aripiprazole)

Question 2

Describe the symptoms and treatments of bipolar depression.

Answer 2

depressed mood, diurnal variation, sleep disturbance, anxiety and sometimes psychotic symptoms

1st line quetiapine, lithium, valproic acid, lithium and lamotrigine or olanzapine and fluoxetine

Question 3

What are the best treatments for maintenance therapy?

Answer 3

1st line is lithium or valproic acid or lamotrigine

Question 4

What is bipolar II?

Answer 4

episodes of hypomania followed by depressive episodes

Question 5

What is the preposed mechanism of bipolar disorder?

Answer 5

may involve excess catechoamine-realted activity, strong familial component

note extreme causes can resemble paranoid schizophrenia

Question 6

Describe the adverse effects of carbamazepine and oxacarbazepine.

Answer 6

structurally similar drugs that block Na+ channels, used alone or in combo with valproic acid
adverse effects: CNS: dizziness, drowsiness, headache, ataxia, abnormal gait, fatigue, NVD, tremor, diplopia, nystgmus, urinary retention terteratogenic,

Question 7

Describe the adverse effects of lamotrigine.

Answer 7

anti seizure drug of unknown mechanism, delays the time to occurrence of mood disorders

adverse effects NVD, hyponatriemia, rash, pruritus, fluid retention, sexual dysfunction, decreased thyroid levels

Question 8

Discuss common drug-drug interactions involving lithium.

Answer 8

ACEI, amphetamines, antiemetic (5-HT3 antagonists, diuretics and anything that lengthens QTc interval

Question 9

Discuss the mechanism, pharmacology, adverse effects and precautions with lithium.

Answer 9

1st line bipolar treatment, complex MOA that inhibits two phosphatase enzymes with inositol recycling; electrolytes/neurotransmitters are effective

Fine tremor, decreased libido, anorexia, ECG abnormailites, bradycardia, xerostomia, altered sense of taste, NVD, polyuria, edema and leukocytosis

take with food, has a narrow therapeutic window, teratogenic

Question 10

Discuss the mechanism, pharmacology, adverse effects and precautions with valproic acid.

Answer 10

1st line treatment for bipolar disorder, efficacy similar to lithium

adverse effectsincreased GABA function, Respiratory depression, hyperammonemia, NVD, hepatic toxicity