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Pharm > Drugs to Treat Bipolar Disorder > Flashcards

Drugs to Treat Bipolar Disorder Flashcards

1
Q

Lithium Clinical Use

A

First-line treatment
Acute mania, bipolar depression, maintenance treatment
Reduces risk of suicide (BP I, BP II, major depression)

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2
Q

How long does it take for Lithium to reach full therapeutic effect?

A

2-3 weeks

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3
Q

Lithium MOA

A

Unclear

  • 2nd messenger enzymes
  • effects neurotransmitters and release
  • effects on electrolytes and ion transport (similar to Na)
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4
Q

Lithium protein binding

A

NONE!

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5
Q

How is lithium excreted?

A

Entirely renal excretion

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6
Q

Effect of Carbonic Anhydrase Inhibitors (ex. Acetazolamide) on Li?

A

Inhibit the proximal convoluted tubule from reabsorbing bicarbonate- Na and Li accompany bicarbonate, overall less Na and Li are absorbed, Li LEVEL GOES DOWN

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7
Q

Effect of osmotic diuretics (ex. Mannitol) on Li?

A

Increase tubular fluid osmolality at proximal convoluted tubule. Leads to an increase in the excretion of water and Na/Li, Li LEVEL GOES DOWN

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8
Q

Effect of loop diuretics (ex. Furosemide) on Li

A

Inhibit Na/K/Cl transport system in the thick ascending loop of Henle. uncertain effect on Li

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9
Q

Effect of Thiazide diuretic on Li

A

Inhibit Na/Cl reabsorbtion in the distal convoluted tubule, compensatory increase in reabsorbtion of Na and Li at the proximal convoluted tubule, Li LEVEL GOES UP

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10
Q

Effect of K sparing diuretics on Li

A

Act on collecting duct, decrease Na and Li reabsorption, Li LEVEL GOES UP

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11
Q

Effect of ACE Inhibitors on Li

A

Inhibits angiotensin II production, increase in Na and Li reabsorption in collecting duct, Li LEVEL GOES UP

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12
Q

Effect of Angiotensin II inhibitors on Li

A

Inhibits angiotensin II production, increase in Na and Li reabsorption in collecting duct, Li LEVEL GOES UP

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13
Q

Other things that can decrease the Li level

A

Aminophylline
Theophylline
Caffeine
Pregnancy

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14
Q

Other things that cause no change in Li level

A

Amiloride
Acetaminophen
Aspirin
Sulindac

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15
Q

Other things that cause increased Li level

A 
NSAIDS
COX-2 inhibitors
Dehydration
Na Depletion
Renal Impairment
Advanced Age
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16
Q

Li Common Side Effects

A 
hypothyroidism
Nausea
Diarrhea
Fine Tremor
Decreased concentration
Sedation
Weight gain
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17
Q

Li Rare Side Effects

A

Increased parathyroid

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18
Q

Li Serious Side Effects

A

Nephrogenic Diabetic Insipidus
Mild renal insufficiency
End stage renal disease
Li toxicity

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19
Q

Before starting Li check:

A 
TSH
Renal Function
ECG (if patient >50 y/o)
Weight (BMI)
Pregnancy test
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20
Q

After starting Li, check:

A

Lithium level

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21
Q

When stable on Li, check___ every 6-12 months:

A

TSH
Renal function
Weight (BMI)
Li level

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22
Q

What is Depakote and what is the advantage to using over Valproic Acid?

A

Valproic acid & Sodium Valproate > pill that is enterically coated, decreased GI symptoms

23
Q

Depakote MOA

A

Unknown, blockage of voltage dependent Na channels

24
Q

Depakote protein binding

A

HIGHLY (90%) protein bound

25
Q

Depakote Drug Drug Interactions

A

Protein displacement: Displaces other protein bound drugs (phenytoin, carbamazepine)
Can be displaced by caffeine and aspirin
Inhibits metabolism of anticonvulsants (carbamazepine, lamotrigine, phenytoin), risk of toxicity

26
Q

Depakote Common Side Effects

A

Nausea, Vomiting, Diarrhea
Ataxia, headache, dizziness, tremor, sedation
Increased ammonia level, weight gain

27
Q

Depakote rare side effects

A

thrombocytopenia, increased suicide risk, alopecia

28
Q

Depakote Toxicity

A

Mild increase LFT’s
Hepatotoxicity (child > 2 on sx med)
Hyperammonemia

29
Q

Before starting depakote check:

A

LFTs
Platelet count
Weight (BMI)
Pregnancy test

30
Q

After starting depakote check:

A

Valproic acid level

31
Q

With depakote, when stable, every 6-12 months, check:

A

LFTs
Platelet count
Weight (BMI)
Valproic acid level

32
Q

Carbamazepine Protein binding

A

Medium (70-80%) protein binding

33
Q

Carbamazepine DDI

A 
CYP450 effects
-increases metabolism of other drugs
-induces UDP-glucuronosyltransferases
-auto-induces its own metabolism
Other drugs can inhibit its metabolism
Other drugs can induce its metabolism
Take Away: It DOES NOT inhibit metabolism of other meds
34
Q

Carbamazepine common SE

A

Nausea, vomiting, weight gain, teratogenic

1011 epoxide: ataxia, diploplia, dizziness, tremor, sedation

35
Q

Carbamazepine rare SE

A

Stevens Johnson Syndrome
hepatotoxic
Aplastic anemia
Agranulocytosis

36
Q

Lamotrigine protein bidning

A

Low protein binding (55%)

37
Q

Lamotrigine metabolism

A

glucuronidation

38
Q

Lamotrigine DDI

A

Depakote causes lamotrigine level to double
Oral contraceptives cause lamotrigine to halve
Carbamazepine cause lamotrigine to halve

39
Q

Lamotrigine SE

A

rash (benign and Stevens Johnson Syndrome)

nausea

40
Q

Second Generation Anti-psychotics for BD Indication

A

Severe Bipolar Mania (psychosis, suicidal/dangeous behavior)
Maintenance treatment
Only 3 for bipolar depression

41
Q

Second Generation Anti-Psychotics Drug Combo

A

Li + SGA or

Depakote + SGA

42
Q

Lithium Teratogenic risk

A

“increased risk of Ebstein’s anomly” but risk is much lower than orginially thought

43
Q

Depakote (Sodium Valproate) teratogenic risk

A

Greatest risk of serious birth defects of all psychotropic meds
Risk of neural tube defects
LAST resort in pregnant

44
Q

Carbamazepine teratogenic risk

A

Neural tube defects

45
Q

Lamotrigine teratogenic risk

A

Least teratogenic risk of mood stabilizers

Possible risk of cleft palate

46
Q

Antipsychotics teratogenic risk

A

Same incidence of major physical malformation as general population (2-5%)

47
Q

Risk of pregnant bipolar patient not taking medicaiton

A

Risk greatly increased of having a mood episode if untreated (37% w/ meds had a mood episode, vs. 85% w/o meds)

48
Q

Which drugs can be used to treat Bipolar I Manic episode Severe:

A 
Lithium
Depakote
FGA's (1st gen anti-psychotics)
SGA's
Benzos (adjunct)
49
Q

Which drugs can be used to treat Bipolar I Manic Non-severe or Bipolar II Hypomanic

A 
Lithium
Depakote
Carbamazapine
FGA's
SGA's
Benzo's (adjunct)
50
Q

Which drugs can be used to treat Bipolar I Maintenance?

A

Continue what worked in treating the acute episode

51
Q

Which drugs can be used to treat Bipolar II Maintenance?

A

Continue what worked in treating the acute episode

52
Q

Which drugs can be used to treat Bipolar I or II Depression?

A 
Lithium
Depakote?
Lamotrigine 
Some SGA's 
Anti-depressants?
Benzo's (at times)
53
Q

Lamotrogine Indication

A

Good for treating bipolar depression, or maintenance Rx

NOT useful in treating bipolar I/II manic/hypomanic episodes

Pharm (20 decks)

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