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NeuroPsych > Therapeutics of Bipolar Disorder > Flashcards

Therapeutics of Bipolar Disorder Flashcards

1
Q

DSM IV Criteria for Manic Episode

A

3+ sx >1week persisting all day long

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2
Q

Sx: DIG FAST

A 
Distractible
Impulsive
Grandiosity
Flight of ideas
Activities = risky
Sleep = none
Talkative
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3
Q

Bipolar I

A

Manic > depressive

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4
Q

Bipolar II

A

Manic < depressive

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5
Q

Which state do most bipolar patients spend their lives in?

A

Depressive

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6
Q

3 Classes of Mood Stabilizers

A

Lithium
SGAs
Anticonvulsants

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7
Q

What is the onset of effect of Lithium for mania vs depressive episodes?

A

Mania: 7-14 days
Depression: 6-8 weeks

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8
Q

Lithium Pregnancy Category and why

A

D - heart defects

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9
Q

Lithium significant kinetics

A

Absorbed readily - not bound
Distributed widely
Linear kinetics
Renally excreted

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10
Q

Lithium TDM

A

Maintenance range: 0.6-1.2
Acute mania range: 1-1.2
>1.2 = NV, diarrhea, tremor, MS changes then seizure and death

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11
Q

Lithium Toxicity

A

Mild: hold dose and get level
Sever: hold dose, get level, hydration, O2, monitor regularly and get labs

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12
Q

Lithium Side Effects

A 
NV: Take with food
Tremor: decrease dose
Weight gain: diet and exercise
Polyuria: decrease dose
Hypothyroidism: synthroid
Acne: topicals
NEPHROTOXIC
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13
Q

Lithium Monitoring

A

Labs
Levels 5-7 days after dose adjustments
Levels and labs every 6 months

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14
Q

Drugs Increasing Li Levels

A

NSAIDs, thiazide diuretics, loops, ACEis

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15
Q

Drugs Decreasing Li Levels

A

K+ sparing diuretics, loop diuretics, theophylline, caffeine

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16
Q

Depakote Preferred Use

A

Mix episodes

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17
Q

Depakote Onset

A

Mania: 3-5 days

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18
Q

Depakote Kinetics

A

Absorbed readily
Highly protein bound
Hepatic excretion

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19
Q

Depakote Pregnancy Category

A

D: neural tube defects

20
Q

Depakote TDM

A

At steady state 12 hours after first dose

TD: 50-100mg/L

21
Q

Depakote Side Effects

A

Tremor, fatigue, NV, weight gain, hair loss, liver and pancreas toxicity, thrombocytopenia

22
Q

Depakote Monitoring

A

Levels at steady state after adjustments

Levels and Lab every 6 months

23
Q

Drugs Increasing Depakote

A

Aspirin, warfarin, fluoxetine, risperidone

24
Q

Drugs Decreasing Depakote

A

Carbamazepine, carbapenems, rifampicin

25
Q

Carbamazepine Onset

A

Second line

Mania: 7-14 days (like Lithium!)

26
Q

Carbamazepine PK

A

Erratic absorption
Highly protein bound
Hepatically metabolize
Autoinduction starts <7 days and stops in 3-5 weeks

27
Q

Carbamazepine Pregnancy Category

A

D: Neural tube defects

28
Q

Carbamazepine TDM

A

After 5 days (steady state)
After 3-5 weeks (post auto-induction)
Range: 4-12

29
Q

Carbamazepine Side Effects

A 
NV
Blurry vision
Dizzy
SJS
Anemia
Agranulocytosis
Liver failure
30
Q

Carbamazepine CIs

A

MAOi use
Bone marrow depression
Hepatic failure

31
Q

Carbamazepine Monitoring

A

HLA - rash
Levels 5 days after adjustments and every 6 months
Labs every 6 months

32
Q

Drugs Increase Carbamazepine

A

Depakote, CCBs, cimetidine, erythromycin

33
Q

Drugs Decreasing Carbamazepine

A

Phenobarbital

34
Q

Drug Carbamazepine Affects

A

Decrease levels of oral contraceptives, theophylline and warfarin

35
Q

Oxcarbazepine Onset

A

Mania: 7-14 days

NOT FDA approved

36
Q

Oxcarbazepine Pregnancy Category

A

C!

37
Q

Oxcarbazepine Interactions and Side Effects

A

Similar but milder than carbamazepine
No autoinduction
CYP inducer - decrease oral contraceptives
NO TDM

38
Q

Lamotrigine Onset

A

First line for depressive episodes

Onset: 6-8 weeks

39
Q

Lamotrigine Dosing

A

SPECIFIC titration schedule
Start over if miss 3-5 doses in a row
With Tegretol: double dose
With depakote: 1/2 dose

40
Q

Lamotrigine Pregnancy

A

C (maybe cleft palate)

41
Q

Lamotrigine Side Effects

A

NV
Fatigue
SJS
Rash

42
Q

Lamotrigine Monitoring

A

Labs every 6 months

No TDM

43
Q

SGAs Onset

A

3-5 days

Emergency management of agitation

44
Q

First Line Acute Mania

A

Lithium
Depakote
Atypical antipsychotics

45
Q

First Line Acute Depression

A

Lithium
Lamotrigine
Zyprexa and SSRI
Seroquel

NeuroPsych (13 decks)

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