Wolters Summary - Antianxiety and Bipolar

Question 1

mixed episodes bipolar

Answer 1

valproate/divalproex

Question 2

bipolar depression

Answer 2

lithium/lamotrigine

quetiapine, lurasidone montherapy

Question 3

mania

Answer 3

lithium

Question 4

lithium MOA

Answer 4

neuroprotective

unknown

Question 5

lithium starts to take effect ____ for anti-manic

Answer 5

1-2 weeks

use benzos or antipsychotics before then

Question 6

lithium starts to take effect ____ for anti depressive effects

Answer 6

6-8 weeks

Question 7

normal blood levels for lithium

Answer 7

0.6-1.2 are OK

higher than that is toxic

Question 8

lithium S.e.

Answer 8

rash 
increased urination 
tremor
hypothyroidism 
increased thirst 
confusion 
teratogenicity

Question 9

what drugs increase lithium concentrations

Answer 9

NSAIDs
Diuretics (ARBs, ACE, Thiazide)

avoid these when taking Li

Question 10

decrease lithium concentrations

Answer 10

pregnancy

theophylline

Question 11

what lab tests are run for pre Li initiation

Answer 11

CBC 
CMP 
TSH 
urinalysis 
pregnancy

Question 12

continual Li monitoring

Answer 12

serum lithium
renal function
thyroid function

Question 13

anticonvulsant list

Answer 13

divalproex/valproate (depacon, depakote)
carbamazepine (tegretol)
lamotrigine (lamictal)

Question 14

divalproex/valproate

Answer 14

(depacon, depakote)

Question 15

carbamazepine

Answer 15

(tegretol)

Question 16

lamotrigine

Answer 16

(lamictal)

Question 17

divalproex MOA

Answer 17

increased GABA

used in acute and maintenance treatment of mania

Question 18

divalproex s.e.

Answer 18

weight gain, hair loss, tremor

HEPATOTOXICITY and TERATOGINICITY (neural tube)

Question 19

carbamexapine s.e.

Answer 19

RASH (specifically asians)
SIADH
fatigue, nausea, blurred vision

CYP3A4 autoinducer

Question 20

oxcarbazine

Answer 20

related to carbamazepine but has less hyponatremia

no auto induction

Question 21

lamotrigine MOA

Answer 21

inhibit glutamine transmission

used for depressed phase of bipolar

Question 22

lamotrigine s.e.

Answer 22

commonL HA, nausea, infection, dry mouth

SJS*** rash

Question 23

lamotrigine with valproate

Answer 23

DECREASE dose by 50%

Question 24

lamotrigine with varbamazepine

Answer 24

INCReASE dose by 50%

Question 25

antipsychotics used in bipolar

Answer 25

depression: quetiapine, lurasidone
maintenance: dispersal consta, abilify mantean

Question 26

antidepressants in bipolar

Answer 26

never use them as a mono therapy

switch to manic phase (esp. SNRI and TCA)

SSRI can be used adjunct

Question 27

benzodiazepam list

Answer 27

Alprazolam (Xanax)
Clonazepam (Klonopin)
Diazepam (Vallium)
Lorazepam (Ativan)

Question 28

long acting bentos

Answer 28

clonazepam

diazepam

Question 29

short acting benzos

Answer 29

alprazolam

lorazepam

Question 30

MOA BZDs

Answer 30

enhance GABA transmission

Question 31

S.e. of BZD

Answer 31

tolerance/dependence (within days)
CNS depression
in elderly- must use LOT

Question 32

BZD BBW

Answer 32

concomitant use of BZD and opioids = respiratory depression, death, coma

Question 33

what schedule are BZDs

Answer 33

schedule 5 controlled substance

limit 5 refills/6months

Question 34

Busprione

Answer 34

a BZD like drug that is used for those with S.A. problems

can be long onset, and short half life so have to take a lot

Question 35

pregabalin

Answer 35

lyrica

schedule 5

Question 36

gabapentin

Answer 36

neurotin

schedule 6

Question 37

pregabalin/gabapentin MOA

Answer 37

NOT synthetic GABA

inhibit glutamate release

Question 38

pregabalin/gabapentin s.e.

Answer 38

dose accumulation with renal insufficiency

Question 39

maintenance treatment of choice for anxiety disorders

Answer 39

SSRI