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Psychopharmacology > Lecture 20: Drugs for Bipolar Disorder > Flashcards

Lecture 20: Drugs for Bipolar Disorder Flashcards

1
Q

diagnostic criteria for bipolar I (vs. II)

A
  1. at least one episode of mania
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2
Q

6 symptoms of mania

A
  1. irritability
  2. high risk activities
  3. inflated self esteem
  4. flight of ideas
  5. distractibility
  6. decreased need for sleep
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3
Q

5 differences between BD and MDD

A
  1. briefer duration
  2. more rapid onset
  3. anergia
  4. psychomotor retardation
  5. reversed vegetative symptoms (overeating and oversleeping)
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4
Q

BD prevalence

A

1%

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5
Q

age of onset

A

15-19

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6
Q

are males and females equally affected?

A

yes for BD1

no for BD2 (women > men)

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7
Q

mortality rate for BD

A

25-50% attempted suicide, 20% completed

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8
Q

compared to depression, BP has

A

higher heritability

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9
Q

BD may be ___% comorbid with another axis I disorder

A

100%

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10
Q

BD has significant reductions in volume of ___ (2)

A

PFC

hippocampus

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11
Q

BD has decrease in number of __ (2) in ___

A

neurons and glial cells

PFC

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12
Q

BD has reduced amount of ___

A

N-acetyl-aspartate

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13
Q

mood stabilizers may reverse impairments in ___

A

BDNF, brain structure

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14
Q

BDNF is part of the ___ family of growth factors

A

neurotrophin

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15
Q

neurotrophin

A

proteins induce survival, development, function, repair, and plasticity of neurns

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16
Q

rita levi-montalcini

A

1986 nobel prize for discovering nerve growth factor (causes developing cells to grow by stimulating surrounding nerve tissue)

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17
Q

lithium increases levels of (2)

A
  1. N-acetyl-aspartate

2. gray matter volume

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18
Q

lithium, valproate, and carbamazepine interact with __-

A

various enzymes involved in 2nd and 3rd messenger pathways

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19
Q

four classes of drugs

A
  1. lithium
  2. anticonvulsant mood stabilizers
  3. atypical antipsychotics (olanzapine)
  4. omega 3 fatty acids
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20
Q

6 anticonvulsant mood stabilizers

A
  1. carbamazepine
  2. valproic acid
  3. gabapentin
  4. lamotrigine
  5. topiramate
  6. oxcarbazepine
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21
Q

lithium efficacy

A

60-80% of acute episodes; 1/3 relapse

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22
Q

2 reasons lithium is used less often

A
  1. difficult to use safely

2. no patent -> low profits

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23
Q

metabolism of lithium

A

excreted unchanged by kidneys

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24
Q

3 (+1) clinical effects against mania for lithium

A
  1. decreases number, frequency, intensity of episodes

2. decreases subtle, transient mood swings between episodes

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25
days for response of Li
5-10 days
26
what percent of people show good to excellent response to Li?
2/3
27
what percent of people show partial response to Li?
80%
28
what percent of Li treated patients have adverse reactions?
35-95%
29
how is Li overdose treated?
dialysis
30
Li has a ___ therapeutic range
narrow
31
variations in __ intake affect Li retention
Na
32
4 most common Li side effects
1. hand tremor 2. incoordination 3. nystagmus 4. muscle weakness
33
choreoathetosis
big body movements that aren't controllable (e.g. flinging your arms up)
34
2 CNS complaints for Li
1. complaints about creativityproductivity | 2. lack/loss of excitement
35
8 other side effects of Li
1. antithyroid 2. polyuria 3. inhib vasopressin 4. dipsogenic 5. weight gain 6. acne 7. toxic arrhythmias in overdose
36
pregnancy risk percent
4-12%
37
what antiepileptic is no longer used?
carbamazepine (tegretol)
38
teratogen
causes malformation in embryos
39
comorbid substance abuse for BD I; BD II?
60% | 50%
40
guideline for manic/mixed episodes
lithium with antipsychotic, valproate with antipsychotic
41
less ill patients are referred to
lithium, valproate, or antipsychotics like olanzapine
42
patients with depressive episodes are commonly prescribed __
lithium, lamotrigine
43
oxcarbazepine difference from carbamazepine
additional oxygen molecule
44
2 benefits of oxcarbazepine over carbamazepine
1. does not induce hepatic enzymes | 2. fewer drug-drug interactions
45
valproic acid MoA
binds to and inhibits GABA transaminase, increasing available GABA. may inhibit GABA reuptake; Na+ action potentials; gene transcription
46
% valproic acid response rate in Li resistant patients
70%
47
valproic acid is best in combination with ___
lithium, olanzapine
48
MoA of carbamazepine
inactivates voltage-sensitive sodium channels (probably 2nd messengers)
49
hyponatremia
electrolyte disturbance in which Na levels are too low
50
leukopenia
decrease in number of WBCs
51
6 side effects of carbamazepine
1. sedation 2. dry mouth 3. blurred vision 4. constipation 5. blood disorders 6. hyponatremia
52
3 major problems with carbamazepine
1. autoinduction of CYP450 2. hepatic toxicity 3. blood problems
53
4 side effects of oxcarbazepine
1. tiredness 2. headache 3. dizziness 4. ataxia
54
oxcarbazepine has been shown to be superior to placebo in the treatment of ___
acute mania
55
carbamazepine should be replaced with ___
oxcarbazepine
56
teratogenic effects of valproic acid
neural tube defects (spina bifida) in first trimester
57
side effects of valproic acid (7)
1. GI distress 2. weight gain 3. liver signs 4. tremors 5. sedation 6. hair loss 7. increased risk of PCOS; menstrual irregularities; hormonal problems
58
lamotrigine half life
26 hours
59
MoA lamictal
inhibits glutamate release
60
about ___ of refractory patients respond to lamictal, vs __ for gabapentin or placebo
50% | 25%
61
about ___% of BD patients improve with topiramate
50%
62
unique advantage of topiramate
weight loss
63
topiramate has greater ___ than gabapentin or lamotrigine
cognitive dysfunction
64
4 side effects of topamax
1. tingling 2. irritability 3. anxiety 4. depression
65
use of topamax as an adjunct
improve efficacy and reduce weight gain of other agents
66
clozapine has more effect on mania or depression?
depression
67
risperidone is more antidepressant or antimanic?
antidepressant
68
hypothesis of antimanic action
dopamine blockade
69
omega 3 MoA
dampen signal transduction mechanisms

Psychopharmacology (22 decks)

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