Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro Quiz 4 > Treatment of Bipolar Disorder > Flashcards

Treatment of Bipolar Disorder Flashcards

1
Q

Medical Conditions that cause Mania

A 
Hyperthyroidism
Addison's/Cushings disease
AIDS
Neurosyphilis
Epilepsy
Post-stroke
Head injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Substance Disorders that cause mania

A

Alcohol
Hallucinogens: LSD, PCP
Anabolic steroids
Methamphetamine/cocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Meds that cause mania

A 
Antidepressants
Clonidine withdrawal
Beta 2 agonist
BZD withdrawal
Sympathomimetics
PK's meds
Corticosteroids
ADHD
Caffeine and theophylline
Thyroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Mania DSM-5 Criteria

A 
>1 week of abnormal increased mood (expressive or irritable) associated with 3 of the following 
- Increased self-esteem
- Decreased need for sleep
Increased talking or pressured speech
- Racing thoughts
- Poor attention
- Increased activity or agitation
- Excessive involvement in high risk for serious consequences
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Manic episodes cause:

A

Impairment of daily function or cause the patient to be hospitalized due to psychiatric symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hypomania DSM-5 Criteria

A

Same as manic by symptoms are less severe

  • Do not impair daily function
  • Observed for at least 4 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bipolar I is diagnosed if:

A

Full manic episode in their lifetime

- May or may not have had depressive episodes (although most do)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bipolar II is diagnosed if:

A

Has both hypomanic and depressive episodes in their lifetime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Specifiers with Mixed Features

A

Switches back and forth from mania/depression
Nearly every day for at least 1 week
Do impair daily function/hospitalized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Specifiers with Rapid Cycling

A

> /= 4 depressive or manic episodes in 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Goals of therapy for BD

A 
Resolve symptoms
Prevent future episodes
Minimize ADE
Increase compliance
Pt and family education
Avoid stressors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment options

A

ECT
Psychotherapy
Pharmacotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Electroconvulsive Therapy use

A

Mania and depressed episodes
Treatment of resistant symptoms or severe suicidal ideation
PREGNANT
- Causes a seizure for 1 minute and treated 6-12 times

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Psychotherapy:

A

Cognitive Behavioral Therapy
Interpersonal therapy
Group therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Traditional Mood Stabilizers

A

Lithium
Divalproex/valproic acid
Carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pharmacotherapy options

A

Traditional mood stabilizers
2nd Gen Antipsychotics (atypical)
Lamotrigine
Antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Acute Manic Episode Treatment

A 
Mood stabilizer (traditional and atypical)
- Antipsychotics for hallucinations/delusions
BZD short therapy to induce sleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Acute Depressive Episode Treatment

A 
Mood stabilizer (Li, lamotrigine, atypicals)
- Antidepressants = adjunct maybe?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Maintenance Phase Treatment

A

Drug used to treat the most recent acute mood episode to be continued

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

First Line Drugs in Acute Manic Episode

A 
Li
Divalproex
Olanzipine
Risperidone
Quetiapine
Aripipazole
Ziprasidone
Asenapine
Paliperidone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

First line Combo Therapy in Acute Manic Episode

A

Lithium or divalproex + risperidone, quetiapine, olanzapine, aripipirazole, OR asenapine

22
Q

First line Drugs in Acute Depressive Episodes

A

Li
Lamotrigine
Quetiapine

23
Q

First line Combo Therapy in Acute Depressive Episodes

A

Li or divalproex + SSRI
Olanzapine + SSRI
Li + Divalproex
Li or divalproex + bupropion

24
Q

Acute Mania Therapeutic range for Lithium

A
  1. 8-1.5 mEq/L

- Increased Li excretion

25
Q

Maintenance Therapeutic range for Lithium

A

0.6-1.2 mEq/L

26
Q

When do you obtain steady state concentration for Lithium

A

5 days and once on maintenance, Q6 months

- 12 hours after the last Li dose

27
Q

5 day follow up always after:

A

Dosage change
Add or d/c a drug that interacts
Renal function change
Predisposing factors for toxicity

28
Q

Valproic acid/Divalproex Therapeutic level

A

50-125 mcg/mL

- Draw levels right BEFORE dose

29
Q

Carbamazepine therapeutic concentration

A

4-12 mcg/mL

- Draw levels right BEFORE dose

30
Q

Carbamazepine PK

A

Food increase bioavailability

Metabolized by 3A4!!!

31
Q

Lamotrigine Drug concentration

A

Not necessary

32
Q

Lamotrigine + what can cause problems?

A

Valproate inhibits metabolism; so start low and titrate conservatively

33
Q

Mild Lithium Toxicity

A 
1.2-1.5 mEq/L
Memory difficulty
Tremor
Weakness
Fatigue
34
Q

Moderate-Severe Lithium Toxicity:

A 
1.5-3.0 mEq/L
Confusion
Lethargy
Ataxia
Emesis
Tremors
35
Q

Severe Lithium Toxicity

A

> 3.0 mEq/L
Irreversible brain damage
Respiratory complication
Coma and death

36
Q

Monitoring with Li

A 
CBC (leukocytosis)
Sodium
Calcium (hyperparathyroidism)
Thyroid (hypo)
SCr and BUN  (dysfunction)
Urine omolality (nephrogenic diabetes)
Weight gain
EKG (QT prolong)
37
Q

Lithium Drug interactions

A
  • No CYP

Avoid diuretics, ACEi, NSAIDs because of sodium

38
Q

Lithium is CI in:

A

Pregnancy
Renal disease
Cardiac disease

39
Q

Divalproex AE

A

Sedation, dizziness

PCOS (polycystic ovarian syndrome)

40
Q

Divalproex Monitoring

A

Liver function (hepatotoxicity)
CBC (thrombocytopenia)
Weight Gain
Ammonia levels

41
Q

Divalproex Interactions

A

Hepatic enzyme inducers or inhibitors

Valproate decrease clearance

42
Q

Divalproex CI

A

Pregnancy
Thrombocytopenia
Liver disease
Pancreatitis

43
Q

Carbamazepine AE

A

Sedation/dizziness
SJS!!!
Osteopenia
Agranulocytosis

44
Q

Carbamazepine Monitoring

A 
Agranulocytosis
Liver function (hepatotoxicity)
Sodium
HLA-B 1502 (SJS)
Take with food!!
45
Q

Carbamazepine Interactions

A

Autoinduces its’ own metabolism aka hepatic enzyme inducer
Other inducers
Increases clearance of contraceptives
Valproate inhibits breakdown

46
Q

Carbamazepine CI

A

Pregnancy
Immunocompromised
Liver disease

47
Q

Lamotrigine AE

A

SJS

Diplopia, headache

48
Q

Lamotrigine Monitoring

A

Rash

49
Q

Lamotrigine Interaction

A

Inducer = increased clearance
Valproate decrease glucuronidation (rash)
Autoinducer of its’ metabolism
Oral contraceptives can decrease concentration

50
Q

Caution with antidepressants in BD

A

Risk of switching to a manic state esp Bipolar I (higher with TCAs and SNRS)

51
Q

Risk of switching = higher in:

A

Higher in Bipolar I
Recent manic or hypomanic episode
Concurrent substance abuse
Greater # = higher risk

52
Q

Recommended Antidepressant in BD

A

Concurrent use with mood stabilizer

- Pts who respond quickly to antidepressant are more likely to relapse if it is d/c

Neuro Quiz 4 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions