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Spring 2024 Therapeutics 3 > Final Bipolar Disorder > Flashcards

Final Bipolar Disorder Flashcards

1
Q

What are the symptoms of bipolar disorder?

A

Mania
Hypomania
Depression
Mixed Mania with Depression

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2
Q

What are the types of Bipolar disorder?

A

Bipolar I Disorder
Bipolar II Disorder
Cyclothymia Disorder
Unspecified Bipolar and Related Disorder
Substance-Induced Mood Disorder

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3
Q

What is hypomania?

A

Less severe mania

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4
Q

What is the primary drug used to treat bipolar disorder?

A

Lithium

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5
Q

What is the mechanism of Lithium?

A

Not completely understood

-Is an ion similar to Na, goes everywhere in the cell, and has lots of different effects

*Depletes PIP2 and associated signaling (membrane lipid that serves as a substrate for phospholipase c)

-Lithium blocks the recycling of PIP2 which causes the Phospholipase C (PLC) to have no substrate and be unable to signal

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6
Q

What are the anticonvulsant drugs used in Bipolar Disorder?

A

Valproic Acid
Sodium Valproate
Carbamazepine/Oxcarbazepine
Lamotrigine (Lamictal)
Topiramate (Topamax)

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7
Q

Which mood is experienced most in bipolar disorder?

A

Depression

*can lead to misdiagnosis

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8
Q

What are the comorbidities often associated with bipolar disorder?

A

Alcohol and substance use (50-60%)

Anxiety disorders (can significantly impact remission of mood episodes if left untreated or inadequately treated)

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9
Q

What is the criteria for Bipolar I Disorder?

A

> or = 1 manic episode

*only need one manic episode to be diagnostic

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10
Q

What is the criteria for Bipolar II Disorder?

A

Hypomanic Episodes

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11
Q

What is the main drug used in bipolar disorder treatment?

A

Lithium

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12
Q

True or False: Lithium is associated with increased suicidality

A

FALSE
-decrease in suicidality in bipolar disorder

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13
Q

What concern is there about lithium dosing?

A

Narrow Therapeutic Index (NTI) drug

*need to make sure patient does not plan on committing suicide by pill overdose

Above 1.2-1.5 mEq/L starts running into toxicity

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14
Q

What is the conversion between different lithium dosage forms?

A

1:1

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15
Q

What are the toxicities associated with Lithium?

A

GI
Ataxia
Course hand tremor
Altered mental status
Seizure
Lethargy
Confusion
Agitation

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16
Q

What are the side effects associated with lithium?

A

Fine hand tremor
Hypothyroidism
Polyuria
Polydipsia
Acne
Dry Mouth
Weight Gain
ECG Changes

Teratogen
-Ebstein’s abnormality

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17
Q

What drug should be avoided in the first trimester of pregnancy?

A

Lithium

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18
Q

What labs should be monitored with lithium use?

A

Na, K, Ca

Parathyroid hormone

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19
Q

What drugs interact with lithium?

A

-ACEi
-ARBs
-Thiazide Diuretics
-NSAIDs*

Dehydration

20
Q

Besides lithium, what is another common first-line agent for bipolar disorder?

A

Valproate

21
Q

What is a risk with the dosing of valproate?

A

Comes in many dosage forms so risk for med errors

22
Q

How does the bioavailability of the extended release lithium form compare to the bioavailability of the delayed release form?

A

Extended release (ER) dosage form is 10-15% LESS bioavailable than the delayed release (DR) form

23
Q

What is the conversion factor between the valproate dosage forms?

A

1:1

*Lower concentrations with ER dosage form but not clinically significant

24
Q

What valproate dosage form has the highest risk for GI ulcerations (esophageal)?

A

Valproic acid syrup (IR) and capsule sprinkle form

25
Q

What valproate serum level is associated with the most efficacy in mania?

A

180-125 mcg/ml

26
Q

When should valproate levels be obtained?

A

96 hours (4 days) after first dose or dose increase

27
Q

What are the side effects associated with valproate?

A

GI: anorexia, N/V/D, dyspepsia, ulceration

Increased appetite (weight gain of 6-8 kg)

Thrombocytopenia (platelet dysfunction)

Teratogenic (neural tube defects and lower IQ)

Hyperammonemia

PCOS in up to 50% of women

28
Q

What trimester of pregnancy is valproic acid unsafe in?

A

ALL

-obtain baseline pregnancy test

29
Q

What labs should be monitored with valproate use?

A

Baseline: Pregnancy test, LFTs, CBC with differential

Serum ammonia (if hyperammonemia suspected, not routine)

30
Q

What drugs interact with valproate?

A

Lamotrigine

-increased lamotrigine serum concentrations increase risk for Stevens-Johnson syndrome

**Dose needs to be cut in half

31
Q

What other mood stabilizers can be used in bipolar disorder?

A

Carbamazepine (Tegretol)
Oxcarbazepine (Trilepta)
Lamotrigine (Lamictal)
Topiramate (Topamax)

32
Q

What important side effect are associated with Carbamazepine (Tegretol)?

A

Thrombocytopenia

Hematologic effects

33
Q

What does oxcarbazepine induce?

A

CYP450 3A4

34
Q

What side effect is associated with oxcarbazepine?

A

Hyponatremia

35
Q

When is Lamotrigine the 1st line treatment in bipolar disorder?

A

For depressive episodes!

36
Q

When is lamotrigine not a good drug option in bipolar disorder?

A

Not useful for acute treatment or manic episodes

37
Q

What are the side effects associated with Topiramate?

A

-Weight loss
-Heat intolerance/ Hypohidrosis
-Metabolic acidosis/Kidney stones
*Possible teratogen (cardiac structural defects)

38
Q

When would we use atypical antipsychotics for bipolar disorder?

A

As monotherapy or can be used in combination with other mood stabilizers (lithium or valproate)

39
Q

What are the monitoring parameters for antipsychotics?

A

Metabolic syndrome and movement side effects

40
Q

What combination therapies can be used in bipolar disorder?

A

Lithium + Valproate

Lithium + Antipsychotic

Valproate + Antipsychotic

Combination with antidepressants

**DO NOT USE TWO ANTIPSYCHOTICS TOGETHER*

41
Q

How long do we use mood stabilizers in bipolar disorder?

A

Long-term

*Considered maintenance treatment to reduce time to subsequent mood episodes

42
Q

What needs to be monitored closely when starting bipolar medications?

A

Suicide attempt risk is high in both poles of bipolar disorder

*monitor closely and use lithium cautiously

43
Q

What are the teratogens used in bipolar treatment?

A

Lithium **first trimester
Valproic Acid
Carbamazepine
Topiramate

44
Q

What is the first-line choice of drug for use during pregnancy?

A

Atypical antipsychotics

45
Q

What are some things to keep in mind with antidepressant use in bipolar disorder?

A

-Need to have maintenance mood stabilizer therapy in combination with antidepressant therapy

-Use serotonergic antidepressants to treat anxiety

-Prefer to use mood stabilizers that target the depressive pole

46
Q

What mood stabilizers target the depressive pole?

A

Lamotrigine
Lithium
Lurasidone
Quetiapine

Spring 2024 Therapeutics 3 (24 decks)

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