Neuroscience Week 8: Bipolar Disorders Drugs

Question 1

Lithium Structure

Answer 1

Li+

Question 2

Lithium MOA

Answer 2

• Inhibits phosphoinositide hydrolysis → (inositol depletion)
• Inhibits glycogen synthase kinase 3 (GSK-3) (↑BDNF, IGFs, WNTs expression)
• Uncouples G-proteins to adenylate cyclase (Vasopressin & TSH)
• Inhibits histone deacetylases - ↑ gene expression (substitutes for Na⁺)

Question 3

Lithium MOA also attributable to Valproate

3 listed

Answer 3

• Inhibits phosphoinositide hydrolysis (inositol depletion)
• Inhibits glycogen synthase kinase 3 (GSK-3) (↑BDNF, IGFs, WNTs expression)
• Inhibits histone deacetylases - ↑ gene expression (substitutes for Na+)

Question 4

Lithium Drug interactions

Answer 4

Few

• Thiazide diuretics & NSAIDs inhibit excretion and potentiate Li⁺ effects
• can potentiate extrapyramidal side effects of some antipsychotics

Question 5

Side effects of Lithium overview

Answer 5

Question 6

Side effects of Lithium critical

Answer 6

monitoring Blood levels because of the low therapeutic index

Question 7

Side effects of Lithium therapeutic range

7 listed

Answer 7

1.0+/- .2 mEq/L

• GI distress
• Polydipsia/polyuria/edema
• Tremors/ (treated with propranolol or Atenolol)
• Ataxia/aphasia/Sedation
• Hypothyroidism (usually subclinical - check TSH 1-2/yr
• Nephritis/Diabetes insipidus/Glomerular sclerosis
• Leukocytosis/Acneform skin eruptions

Question 8

Side effects of Lithium toxic range

3 listed

Answer 8

• Hypotension → arrhythmias/conduction block
• Marked ataxia/confused states
• Coma/convulsions

Question 9

Lithium Overdose Treatment

Answer 9

Hemodialysis

Question 10

Agents used in treating bipolar mania overview

Answer 10

Question 11

Agents used in treating bipolar mania: Acute presentation

2 listed

Answer 11

• Antipsychotics (olanzepine, Apriprazole)
• Benzodiazepines (as anxiolytics if indicated)

Question 12

Agents used in treating bipolar mania: Long-term management

2 listed

Answer 12

• Lithium OR Anticonvulsants (Valproate, Carbamazepine, Oxcarbazepine)
• Antipsychotics (continued if indicated)

Question 13

Issues in treating Bipolar Mania

4 listed

Answer 13

Question 14

Agents used in treating Bipolar Depression

4 listed

Answer 14

Question 15

Issues in treating Bipolar Depression

3 listed

Answer 15

Question 16

Repurposing drugs for bipolar conditions

Answer 16

Question 17

Neuropsychopharmacology landscape

Answer 17

Question 18

Question

Answer 18

D. Valproate

Question 19

Question

Answer 19

C. Tyramine

Question 20

Question

Answer 20

E. Positive allosteric modulation of GABA_A receptors

Question 21

Question

Answer 21

C. alpha constriction blood vessels to maintain increased BP