Pharmacology: Bipolar Disorder

Question 1

Drugs focused on for Bipolar Affective Disorder

Answer 1

Mood Stabilizers (can use antipsychotics, antidepressants, and benzodiazepines as well but focused on mood Stabilizers)

Question 2

This drug is FDA approved for Epilepsy but NOT for bipolar disease

Answer 2

Oxcarbazepine

Question 3

Drug of choice for mixed episodes/features (hyper and hypomanic states) and rapid cycling.

Answer 3

Either Lithium or Valproic Acid

Question 4

Drug that has adverse effects of nausea, diarrhea, polyuria, polydipsia, weight gain, tremor, fatigue, confusion, and somnolence. Also possibility of hypothyroidism, skin reactions, leukocytosis, cardiac abnormalities, and diabetes inspidus.

• Associated with higher serum levels, therefore really monitor them!

Answer 4

Lithium

Question 5

This drug goes through renal elimination, therefore needs to look out for drugs/substances that decrease the GFR such as…

Answer 5

• Lithium

- Decrease GFR => NSAIDS, ACE-I, ARBs, and diuretics.

Question 6

FDA approved for Bipolar Disorder, Seizure Disorder and Migraines

Answer 6

Valproic Acid

Question 7

Has an adverse effect of causing thrombocytopenia

Answer 7

Valproic Acid

Question 8

Pregnancy Category D Drugs used to tx Bipolar disease

Answer 8

Lithium, Valproic Acid, and Carbamazepine

• Needs 2nd form of birth control because it’s Category D (?, was only mentioned for Carbamazepine and Oxcarbazepine, one of which is category C)

Question 9

Pregnancy Category C Drugs used to tx Bipolar disease

Answer 9

Lamotrigine and Oxcarbazepine

Question 10

Drug that has rare adverse effect of Rash and/or Steven Johnson Syndrome (SJS)

Answer 10

Lamotrigine

- Note: avoid new medications, foods, products, for the next few months to make sure that it wasn’t an external cause.

Question 11

• Drug that has rare adverse effect of Steven Johnson Syndrome/Toxic Epidermal Necroylysis (thought to be the same condition), blood dyscrasias, and hepatic failure.
• Gene linked to SJS

Answer 11

Carbamazepine

• Asian ancestry for HLA-B*1502 gene

Question 12

FDA approved for Bipolar Disorder and various seizure disorders

Answer 12

Lamotrigine

Question 13

FDA approved for Bipolar Disorder, epilepsy, and trigeminal neuralgia

Answer 13

Carbamazepine

Question 14

Drug that is good for Bipolar depression and bipolar II maintenance specifically (w/o manic episodes)

Answer 14

Lamotrigine

Question 15

Drug that is an inducer of many cytochrome p450 isoenzymes and autoinducer of 3A4

Answer 15

Carbamazepine

Question 16

Drug that is a 3A4 inducer but not an autoinducer

Answer 16

Oxcarbazepine

Question 17

Drug(s) good for mania/hypomania states

Answer 17

Lithium, Valproate, Carbamazepine, and Oxcarbazepine.

• if rapid cycler = think more Valproate Acid or Lithium.

Question 18

Black Box Warning for Mood Stabalizers

Answer 18

Increase the risk of suicidal behavior or ideation (2x). especially in patients with epilepsy.

Question 19

Drug that is not a mood stabalizer that is indicated for Bipolar depression

Answer 19

Symbyax (combo of olanzapine and fluoxetine)

Question 20

Drug that is not a mood stabalizer that is indicated for acute management of agitation/mania

Answer 20

Benzodiazepines (esp. Lorazepam)