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Psychiatry pro +1700 > Somatic Therapies III > Flashcards

Somatic Therapies III Flashcards

1
Q

What are the two drugs approved for bipolar maintenance?

A
  • Li

- Lamotrigine

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2
Q

What are the three drugs that are helpful for the depressive stage of bipolar disorder?

A
  • Olanzapine
  • Quetiapine
  • Lurasidone
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3
Q

What is the onset of action of Li?

A

5-7 days

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4
Q

What organ metabolizes Li?

A

Renal

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5
Q

What is the WBC abnormality that can occur with Li use?

A

Demarginalization causing leukocytosis

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6
Q

True or false: Li is rapidly absorbed

A

True

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7
Q

What are the pharmacokinetics of Li?

A

Linear

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8
Q

What are the side effects of Li?

A
  • Polyuria/polydipsia
  • Acne
  • Hypothyroidism
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9
Q

How often should Li levels be checked?

A

Monthly for 3 months, then q 3 months

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10
Q

What are the drugs that increase Li levels?

A

Na depleting diuretics

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11
Q

Where is Li reabsorbed in the kidney?

A

Proximal tubule

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12
Q

Long term use of Li can increase what lyte level?

A

Ca

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13
Q

What are the cognitive side effects of Li?

A
  • Distractibility
  • poor memory
  • Confusion
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14
Q

What are the congenital effects of Li?

A

Ebstein cardiac anomaly

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15
Q

When does Li toxicity come into play?

A

1.5 levels and above

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16
Q

What is the treatment for Li toxicity?

A

Dialysis

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17
Q

When is divalproex used for bipolar?

A

Rapid cyclers

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18
Q

What is the MOA of divalproex?

A

Increase GABA by inhibiting degradation and stimulating synthesis

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19
Q

What organ metabolizes divalproex? What are the labs that are monitored?

A
  • Hepatic

- LFTs, CBC

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20
Q

What are the teratogenic effects of divalproex?

A

NTDs

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21
Q

What are the side effects of divalproex?

A
  • Toxic hepatitis
  • Hair loss
  • PCOS
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22
Q

What are the effects of divalproex in prego?

A

NTDs

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23
Q

What is the MOA and use of carbamazepine?

A
  • Acute mania and bipolar

- Na channel blocker and GABA agonist

24
Q

What is the major side effect of carbamazepine?

A

Aplastic anemia

25
Q

What is the MOA and use of lamotrigine?

A
  • Na channel blocker

- Seizures

26
Q

What is the major side effect of lamotrigine? What must be done to prevent this?

A
  • Steven-Johnson syndrome

- Start slow and titrate up

27
Q

What is the role of topiramate and gabapentin in the treatment of bipolar disorder?

A

No evidence of efficacy

28
Q

What are the three major first line drugs in the treatment of Bipolar disorder?

A

Li
Valproate
Lamotrigine

29
Q

What is the role of SGAs in the treatment of bipolar disorder?

A

second line

30
Q

What is considered an adequate trial of Li, valproate, or lamotrigine?

31
Q

What is the second line treatment for Bipolar?

A

Anticonvulsant + Li
or
SGAs + Li

32
Q

True or false: most Bipolar DOs need only one drug

A

False–need 2+

33
Q

What is the role of ECT for bipolar disorder?

A

Refractory dz

34
Q

How hard to treat is depression with bipolar disorder, relative to MDD? Mania?

A

Depression is Much harder, but mania relatively easy

35
Q

What is the difference between bipolar I and II?

A 
I = classic
II = hypomania
36
Q

If you have a pt with refractory depression, what should always be suspected?

37
Q

True or false: most of the time, bipolar patients are either euthymic, or depressed, but rarely manic

38
Q

What is the thinking of the MOA of ECT?

A

downregulate beta-receptors

39
Q

What has the highest success rate for depression?

40
Q

What are the three major indications for ECT?

A
  • Refractory depression
  • Severe suicidal ideation
  • Depression + refusal to eat/drink
41
Q

How many treatments are needed for ECT?

A

6-12 weeks, with 3 treatments per week

42
Q

What is the role of atropine in ECT?

A
  • Prevent bradyarrhythmias

- Reduce secretions

43
Q

What are the adverse effects of ECT?

A
  • Fractures d/t muscle relaxant
  • Postictal confusion
  • Memory impairment
44
Q

What is the effect of ECT on anterograde memory?

A

Minimal evidence that it affects it

45
Q

What are the two meds for ADHD?

A
  • Methylphenidate (ritalin)

- Dextroamphetamine (adderall)

46
Q

What is the MOA of clonidine?

A

Alpha-2 agonism

47
Q

What are the side effects of stimulants?

A
  • Anorexia
  • Emotional lability
  • Tics
48
Q

What are the CV effects of stimulants?

A
  • Increased HR

- Sudden death

49
Q

What are the usual hallucinations with stimulant use?

A

Feeling bugs on their skin

50
Q

What is the general MOA of stimulants?

A

-Blockade of NE and dopamine reuptake

51
Q

What is the major problem with stimulants use and ADHD?

A

Physicians keep increasing the dose to treat multiple, comorbid ADHD issues

52
Q

When are stimulants used in depression?

A

Treat persistent anergia or amotivation

53
Q

Is it ethical to prescribe stimulants for neuroenhancement?

A

Yes, but insurance will not cover it

54
Q

What is the MOA and use of atomoxetine? Risks/benefits?

A

NE reuptake inhibitor to treat ADHD–lower side effects, longer effect but less efficacious

55
Q

True or false: age and weight are good predictors for dosing stimulants

56
Q

What is the MOA of guanfacine?

A

Alpha-2 agonist

57
Q

What are the contraindications for ECT?

A
  • Heart issues

- Increased ICP or space occupying brain lesion

Psychiatry pro +1700 (28 decks)

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