Ott Bipolar Flashcards
mood pole often experienced in bipolar
depression
comorbidities with bipolar
alcohol and substance abuse
anxiety disorder
bipolar 1 disorder classification
greater than 1 manic episodes
bipolar II disorder classification
hypomanic episodes
1st line treatment bipolar
lithium or valproic acid
lithium associated with what
decrease in suicidality
narrow therapeutic index (could overdose)
dosage forms of lithium ratio
1:1
what can happen if a lithium overdose
renal function decrease, dialysis
lithium toxicities
GI
ataxia
coarse hand tremor
altered mental status
seizure lethargy
confusion
agitation
lithium side effects
fine hand tremor
hypothyroidism
polyuria
polydipsia
acne
dry mouth
weight gain
ECG
lithium should be avoided when?
1st trimester (teratogenic)
cause cardiac structural abnormality
lithium monitoring
everything
renal stuff especially
drug interactions with lithium decreased clearance
ACE
ARB
thiazide diuretics
NSAIDS
(increase lithium levels 25%)
drug interactions with lithium increased clearance
caffeine
osmotic diuretics
loop diuretics
(decrease lithium levels)
which drug available in multiple dosage forms and risk for med errors
valproate
which dosage form less bioavailable than DR
ER - 10-15%, lower serum concentrations
which valproate dosage forms higher risk for side effects
valproic acid syrup (IR) and capsule sprinkle
higher risk for GI ulcers (esophageal)
serum valproic acid range for efficacy with mania and when should we measure
80-125 mcg/mL, obtain 4 days after first dose or increase
pregnancy with valproic acid
unsafe in all trimesters
obtain baseline pregnancy test
neural tube defects (IQ of offspring down)
common side effect of valproic acid in women
polycystic ovary syndrome
PCOS can occur with what drug
valproic acid
side effects valproic acid
anorexia, N/V/D, dyspepsia, ulceration
increased appetite/weight gain
thrombocytopenia, platelet dysfunction
hyperammonemia
lab monitoring in valproic acid
pregnancy test
LFTs
CBC
serum ammonia (if we suspect hyperammonemia)
drug interaction with valproic acid
lamotrigine - increased serum conc
risk stevens johnson syndrome
which drug associated with thrombocytopenia/hematologic effects
carbamazepine
oxcarbazepine CYPs
3A4 inducer (no autoinduction)
which drug associated with hyponatremia
oxcarpazepine
lamotrigine use in bipolar
depressive symptoms
Not useful in manic symptoms or acute treatment
topiramate side effects
weight loss
heat intolerance
metabolic acidosis
kidney stones
topiramate pregnancy
possible teratogen
cardiac structural defects
atypical antipsychotics are approved for what in bipoilar
acute/maintenance treatment with or without psychosis
which antipsychotics arent FDA approved for bipolar
brexiprazole
clozapine
iloperidone
paliperidone
atypical antipsychotics in bipolar therapy
monotherapy or in combo with (valproate/lithium)
what applies for antipsychotics in bipolar disorder
monitoring parameters for metabolic syndrome and movement side effects
suicide risk in which pole of bipolar
mania and depression (use lithium cautiously)
which drugs are teratogens
lithium
valproic acid
topiramate
carbemazepine
which drugs better option in pregnancy
antipsychotics
what do we need in combo with antidepressants in bipolar?
mood stabilizer
what do we treat anxiety with in bipolar
serotenergic antidepressants
preferred mood stabilizers in depression
lamotrigine, lithium, lurasidone, quetiapine
