Pharm Final: Bipolar Syndrome

Question 1

What are the characteristics of bi-polar?

Answer 1

depression and manic phases separated by distinct phases of normal behavior

Question 2

What is path physiology of bipolar?

Answer 2

complex but believed that hypothalamic-pituitary-adrenal axis affects serotonin, blockage of serotonin receptors

Question 3

What are signs and Sx of mania?

Answer 3

racing thoughts, impulsive, euphoric, poor judgment, increased energy

Question 4

What is the goal of bipolar drug tx?

Answer 4

keeping balance between mania and depression

Question 5

What is goals for acute episodes?

Answer 5

goal: keep pt safe, quick control
strategy: short term use of antipsychotic agent or potent sedative (lorazepam, clonazepam)

Question 6

What is goal for chronic illness?

Answer 6

goal: stabilize pt mood, prevent reoccurrence
strategy: long term use of mood stabilizers

Question 7

What are main mood stabilizers?

Answer 7

Lithium, valproic acid, carbamazepine, lamotrigine

Question 8

What are second generation antipsychotic?

Answer 8

olanzipine, quetiapine, aripiprazole

Question 9

What are the main points to remember with mood stabilizers?

Answer 9

1. goal is to delay set of next acute episode
2. will not stop mood changes from occurring
3. must be taken continuously to be effective

Question 10

What is the difference between mood stabilizers and antidepressants?

Answer 10

mood stabilizers like lithium prevent both depression and manic, but AD treat depression but may cause increased manic phase

Question 11

What is MOA for lithium?

Answer 11

unknown but believed to control neural excitability

Question 12

What is main use for lithium?

Answer 12

70-80% effective in treating manic episodes within 14 days but full effect may take up to 4 weeks

Question 13

Does lithium have a wide or narrow TI?

Answer 13

narrow- 0.8-1.0 mEq/L and up to 1.5 in acute episodes

Question 14

What is absorption method of lithium?

Answer 14

absorbed through GI system and spread to all tissues in the body

Question 15

What are main SE of lithium?

Answer 15

GI, fatigue, weakness

50% of ppl with tremors

70% with polydyspia and polyurea

40% with memory impairment and inability to concentrate

Question 16

Why are there so many SE with lithium?

Answer 16

it is not metabolized and excretion takes place mostly through urine, tends to accumulate

Question 17

What are major drug interactions with lithium?

Answer 17

NSAIDS, ACE I, ARB’s, thiazide diuretics can cause increase in lithium levels

caution when using with antipsychotics due to potential for increased neurotoxicity

Question 18

What are anti epileptics used as mood stabilizers?

Answer 18

Valproic Acids, Carbamenzapine, lamotrigine, gabepentin

helps you with neural excitation