Week 13 - Mood stabilizers Flashcards
Bipolar I definition
Manic episodes with or without psychosis and/or major depression
Bipolar II definition
Hypomanic episode w/ major depression
No history of manic or mixed episode
Cyclothymia definition
Hypomanic and depressive symptoms that do not meet criteria for bipolar II
No major depressive episodes
What medications could be prescribed to treat acute mania?
Agents can be used alone or in combination to bring the patient down from a high
- Lithium, valproate, carbamazepine, clonazepam/lorazepam, SGAs
True/False: Antidepressant monotherapy may precipitate mania or induce rapid-cycling disorders between mania and depression
True
- Fixed combination of olanzapine and fluoxetine can treat acute bipolar depression for an 8 week period w/o inducing switch to mania or hypomania
Patients with bipolar in the depressed phase do not respond to treatment w/ standard antidepressants. What medications could be prescribed in this case?
Lamotrigine or low dose ziprasidone
What therapy may be useful for patients w/ bipolar depression who do not respond to lithium or other mood stabilizers?
ECT
Which three medications, alone or in combination, are the most widely used agents in the long-term treatment of patients w/ bipolar?
- Lithium
- Carbamazepine
- Valproic acid
True/False: Lamotrigine has prophylactic antidepressant and mood stabilizing properties
True
- Slow increases help avoid the rare side effect of lethal rash
Lithium: indications
- Manic episodes
- Maintenance treatment of manic depressive patients w/ history of mania
- Off-label: bipolar depression, MDD
Lithium: monitoring
- Before intiating therapy
- Kidney function tests, TSH, EKG in those over 50 years
- During therapy
- Kidney function once or twice a year
- Frequent monitoring of trough levels
- Metabolic syndrome (BMI, lipids, A1C)
Valproate/Depakote: indications
- Acute mania and mixed episodes
- Off label: maintenance of bipolar, bipolar depression, psychosis, schizophrenia
Valproate/Depakote: monitoring
- Prior to planned surgery
- Platelet counts, LFTs, coagulation tests
- Recurrent
- LFTs and platelets over first few months then once or twice per year
- Plasma drug levels
- Metabolic syndrome
Lamotrigine (Lamictal): indications
- Maintenance of bipolar
- Off label: bipolar depression, bipolar mania, neuropathic pain/chronic pain, MDD
Lamotrigine (Lamictal): monitoring
None required
- Ophthalmological checks may be considered
- Consider baseline kidney/liver function for potential dose adjustment needs
