Exam 3: Bipopo Flashcards
First line treatment for acute bipolar depression
lithium - vey good at anti-suicide (NOT as monotherapy)
valproate (NOT as monotherapy)
quetiapine
Mainstays of treatment for both bipolar acute mania and prophy for recurrent manic and depressant episodes
lithium
valproate
T/F: bipolar augmentation agents should be tapered and dc’d when the acute mood episode remits and the pt is stabilized
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Antipsychotic meds that are FDA approved for bipolar acute mania and mixed episodes
lithium, valproate
CBZ
aripiprazole
asenapine
cariprazine
olanzapine
quetiapine
risperidone
ziprasidone
Antipsychotic meds that are FDA approved for bipolar maintenance
- lithium
- lamotrigine
- aripiprazole
- olanzapine
- quetiapine
- risperidone
- ziprasidone
Antipsychotic meds that are FDA approved for bipolar ACUTE depression MONOtherapy
cariprazine
lumateperone
lurasidone
olanzapine/fluoxetine
quetiapine
lithium and VPA are adjunct
Which second gen antipsychotic LAIs are approved for BPD
- Aripiprazzole (only Maintena and Asimtufli, NOT Aristada)
- Risperidone (only Consta and Rykindo, NOT Perseris) - can be monotherapy an adjunct to lithium or valproate
Treatment guidelines for bipolar acute manic and mixed episodes
- options: lithium, VPA, SGA; combo of LI/VPA with an SGA may be more effectve
- benzos (usually clonazepam and lorazepam) are an adjunct option d/t antimanic properties
- FGAs are an option d/t antimanic properties
- dc antidepressants if possible
Of the second gen antipsychotics, which are NOT apporved for bipolar disorder?
- breixipiprazole (schizo and MDD)
- clozapine (only for schizo)
- iloperidone (only for schizo)
- paliperidone (only for schizo)
- pimavanserin (parkinsons psychosis)
Treatment guidelines for bipolar acute major depressive episodes
- initial monotherapy options: Li, lamotrigine, quetiapine, lurasidone, or olanzapine/fluoxetine
- AVOID aripiprazole and ziprasidone
- AVOID TCA and SNRI (may switch to manic)
Lithium onset
- mania: 6-10 days
- depression: 6-8 weeks
only onset → not good for acute or for rapid cyclers
Lithium AE
- may unmask Brugada syndrome
- NDI (nephrogenic diabetes insipidus); kidney injury
- CV
- GI and CNS → take with food to minimize
- floppy baby syndrome for nursing mothers (in breastmilk)
- muscle weakness and lethargy
- polydipsia
Lithium CI
renal or caridac disease
Lithium monitoring
- Renal (SCr, BUN) - only renally eliminated; NO hepatic involvement STAY HYDRATED (renal impairment and hyponatremia can increase level)
- thyroid (hypothyroid, goiter)
- lithium [ ]
- baseline PE and general chem for preggers (not techniclaly teratogenic, but not great)
- CBC with diffferential
- FG, lipids, weight, waist circumferance
- serum electrolytes
- derm - disfiguring acne
Lithium DDI
- NSAIDs - increase Li level
- ACE, ARB - increase Li level
- diuretics - increase Li level
- CCB
- clozapine (blood dyscrasia with dc)
- antipscyhotics →NMS
- caffeine → reduces LI [ ]
- theophylline → reduces [ ]
