Drugs for Bipolar Disorders

Question 1

Drugs for bipolar disorders - list

Answer 1

Lithium
Olanzapine
Valproate
Lamotrigine

Question 2

Bipolar disorders - Acute manic emergencies

Answer 2

Key is sedation - use antispychotics - haloperidol. Olanzapine and valproate can work too. Benzos can help.

Question 3

Bipolar disorders - Maintenance

Answer 3

Mood stabilizers - treat both poles - see drug list.

Question 4

Antidepressants in treating bipolar disorders

Answer 4

Can cause problems - acute mania. May also increase rapidity and depth of cycles.
The problem is that a bipolar patient is not likely to seek treatment during a manic episode, because they think everything is great. Consider family history. Lithium can be helpful in treating depression.

Question 5

Lithium mechanism of action

Answer 5

No one knows, but it seems to work 80% of the time. Drug of choice for maintenance.

Question 6

Lithium Indications

Answer 6

Bipolar (obviously) - Not a good choice for acute manic emergencies.
Good for depression, as an adjunct
Schizoaffective disorder, as an adjunct.

Question 7

Lithium ADME

Answer 7

PO, wide distribution, peak plasma 2-4 hrs after dose. Excreted in urine at 20% creatinine clearance rate.
Narrow therapeutic window - monitor blood levels.

Question 8

Lithium DDI’s

Answer 8

Mannitol, Acetazolamide, and Theophylline increase lithium excretion.

Increased sodium excretion (diuresis) causes decreased lithium excretion. This can lead to toxicity. Watch out for loops, thiazides, dehydration, NSAIDS, and ACE inhibitors.

Question 9

Lithium Adverse Effects

Answer 9

Sedation, fatigue, Diarrhea, Nausea, Tremor, Edema, mild hypothyroidism, polydipsia, polyuria, skin problems.

Acute overdose - confusion, ataxia, hypotension, arrythmias, convulsions, coma.

So why wouldn’t you want to be on it?

Question 10

Lithium Toxicity - why does it happen?

Answer 10

Narrow TI - small changes in renal clearance can turn a therapeutic dose toxic.

Question 11

Anticonvulsants for treating bipolar

Answer 11

Valproate (Depakote)

Lamotrigine (Lamictal) - also has a strong antidepressant effect.

Question 12

Valproate side effects

Answer 12

This drug sucks. It makes you fat to the point of diabetes, and bald (although that’s not in the slides)
It also causes GI distress, sedation, and rare hepatotoxicity.

Question 13

Iamotrigine Side effects

Answer 13

Nausea, dizziness, Headache, Mild Rash

Rare - Stevens Johnson Sydrome

Question 14

Antipsychotic for bipolar disorders

Answer 14

Olanzapine (Zyprexa)

Question 15

Olanzapine advantages/disadvantages

Answer 15

Equivalent to lithium for bipolar 1, significant sedation makes it good for manic emergencies, but, like all atypicals, it will make you fat and give you diabetes.