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Notes/Facts/Brand vs Generics part 3 > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A
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2
Q

Bipolar Disorder:

A

is characterized by fluctuations in mood from an extremely sad or hopeless state, to an abnormally elevated, overexcited or irritable mood called mania or hypomania (a milder form of mania)

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3
Q

Each mood episode represents a drastic change from an individual’s usual mood and behavior.

A

Some episodes include symptoms of both mania and depression, which is called a mixed state. Individuals may seek help during a depressive episode, which can lead to a misdiagnosis of depression only.

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4
Q

Bipolar disorder is classified as ____________ or ____________. Which differ primarily by the severity of _______ experiences.

A

Bipolar 1 OR Bipolar 2

mania

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5
Q

The _______ are used to diagnose bipolar disorders and a ________ should be done prior to starting treatment to rule out a drug-induced mania.

A

DSM-5 criteria

toxicology screen

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6
Q

What is mania?

Definition:

A

abnormally elevated or irritable mood for at least a week (or any duration if hospitalization is needed)

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7
Q

What is mania?

Symptoms:

A
  • Inflated Self-esteem
  • Needs less sleep
  • More talkative than normal
  • Jumping from topic to topic
  • easily distracted
  • Increase in goal directed activity
  • High-risk, pleasurable activities (buying sprees, sexual indiscretions, gambling)
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8
Q

Drug treatment:
- mood stabilizer (lithium)
- antiepileptic
- SGAs

What is the goal for drug treatment?

Where do mood stabilizers fit in therapy?

Where do antiepileptic medications fit for therapy?

Where do SGAs fit for therapy?

A
  • Stabilize the mood without inducing depression or mania
  • Mood stabilizers (lithium) treat both states (depressive or manic) without inducing either state
  • The antiepileptics also treat both mania and depression without inducing either state*
  • Antipsychotics, while not traditional mood stabilizers, can help stabilize the mood when mania occurs with psychosis
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9
Q

Why can’t we use antidepressants as monotherapy in bipolar disorder?

A
  • Antidepressants can INDUCE or exacerbate a manic episode when used as monotherapy. So, they should only be used in combination with a mood stabilizer if treating bipolar disorder.
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10
Q

For Acute Treatment - this is determined by the type of episode patient is having.

For a MANIC episode: 1st line treatment is ___________1_______

A combination of an _____2________ + ________3______ is preferred for severe episodes.

A

1)- Valproate, Lithium or an antipsychotic- SGA

2) SGA + 3) lithium OR valproate

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11
Q

For Acute Treatment - this is determined by the type of episode patient is having.

For a DEPRESSIVE episode: 1st-line treatment is _______1_______. _____2______ can be added OR used as alternatives.

A

1) antipsychotic-SGA (quetiapine/lurasidone)

2) lithium, valproate, or lamotrigine

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12
Q

_______________ is required for ALL

____________ (due to the suicide risk)

____________ (due to increased risk of death in elderly patients with dementia-related psychosis)

A

MedGuides

antidepressants

antipsychotics

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13
Q

Treating bipolar disorder in Pregnancy is complex since the common mood stabilizers have known ______________.

A

teratogenic effects

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14
Q

Treating Bipolar disorder in pregnancy

  • ___________1_________ exposure in pregnancy can increase the risk of fetal anomalies, including neural tube defects, fetal ____________ syndrome, and long term adverse cognitive effects.

AVOID in pregnancy, if possible, especially during the first trimester.

A

1) Valproate

2) fetal valproate syndrome

what are characteristics of fetal valproate syndrome:

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15
Q

Treating Bipolar disorder in pregnancy

  • ________________ exposure in pregnancy can cause fetal _____2______ syndrome, which can result in _____3_____.

AVOID in pregnancy, if possible, especially during the first trimester.

A

1) carbamazepine

2) fetal carbamazepine syndrome

3) facial abnormalities and other significant issues

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16
Q

Treating Bipolar disorder in pregnancy

  • ____________ exposure in pregnancy can cause an increase in congenital cardiac malformations and other abnormalities.
A

lithium

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17
Q

what are characteristics of fetal valproate syndrome:

A
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18
Q

what are characteristics of fetal carbamazepine syndrome:

A
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19
Q

During pregnancy: __________ is a safer option relative to other mood stabilizers.

__________ are safer choices than valproate, carbamazepine, or lithium. __________ has the most favorable safety profile in pregnancy but its use is limited since it is only approved for Bipolar depression.

A

lamotrigine

SGAs

lurasidone (Latuda)

20
Q
A
21
Q

Lithobid

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

lithium

Class: mood stabilizer

Indications: Bipolar Disorder

MOA: MOA is proposed to work by influencing the reuptake of serotonin, and/or NE or by moderating glutamate levels in the brain.

Dosage forms: tablet, capsule, syrup

Dosing:
Start: 150-900mg/day, divided BID-TID
Usual range: 900-1800mg/day, divided BID-TID——TID-QID

ER- take BID
titrate slowly, as tolerated.
Take with or after meals to reduce nausea.

Therapeutic range: 0.6-1.2 mEq/L (trough level)
Acute mania may require up to 1.5mEq/L initially.

Contraindications:

Warnings:
renal impairment, hyponatremia, and dehydration (increase lithium toxicity)
**Serotonin Syndrome

Side Effects:
- GI upset (nausea/diarrhea), *cognitive effects, *cogwheel rigidity (stiffness when elevating appendage in increments), *fine hand tremor, thirst, polyuria/polydipsia, *weight gain, hypothyroidism
blue-gray skin pigmentation

Monitoring:
- serum lithium levels should be monitored to avoid toxicity
- renal function, thyroid function (TSH, FT4), electrolytes (calcium, potassium, sodium)

Pearls/Notes:
- Treats both mania and depression without inducing either state*

- renally cleared; no CYP interactions

- Avoid in pregnancy; associated with cardiac malformations in first trimester; avoid in breastfeeding

- Maintain adequate hydration with non-caffeinated fluids (Caffeine can decrease levels)

Drug-Drug/Food interactions:

22
Q

When Lithium level is > 1.5mEq/L:

Toxicity symptoms include-

A

ataxia (loss of muscle coordination)- impaired coordination
coarse hand tremor
vomiting
persistent diarrhea
confusion
sedation

23
Q

When Lithium level is >2.5 mEq/L

Toxicity symptoms include-

A

CNS depression
arrhythmia
seizure
coma

24
Q

Lithium Drug Interactions:

Lithium levels will Increase with:

A

**-decreased salt intake, sodium loss (*with ACE inhibitors, ARBs, thiazide diuretics)
**- NSAIDs: aspirin and sulindac are safer options

25
Q

Lithium Drug Interactions:

Lithium levels will Decrease with:

A

-increase salt intake, caffeine and theophylline

26
Q

Lithium Drug Interactions:

increased risk of serotonin syndrome if lithium is taken with _________

A

SSRIs, SNRIs, Triptans, Linezolid (Zyvox), and other serotonergic agents

27
Q

Lamictal

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

lamotrigine

Class: antiepileptic

Indications: bipolar depression

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:
- rash
- *increased risk of RASH when used with Valproate

Pearls/Notes:
- Treats both mania and depression without inducing either state*
- Not useful for Acute mania due to slow titration required

Drug-Drug/Food interactions:

28
Q

Depakote, Depakene

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

valproate/valproic acid derivatives

Class: antiepileptic

Indications: bipolar disorder

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects: *weight gain

Monitoring:

Pearls/Notes:
- Treats both mania and depression without inducing either state*
- Valproate inhibits lamotrigine metabolism, so starting with a much lower dose of lamotrigine.

Drug-Drug/Food interactions:

29
Q

Equestro

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

carbamazepine

Class: antiepileptic

Indications: dipolar disorder

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- Treats both mania and depression without inducing either state*

Drug-Drug/Food interactions:

30
Q

Abilify

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

aripiprazole

Class: second generation antipsychotic (SGA)

Indications: schizophrenia,

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-FDA approval for adjunctive therapy in major depressive disorder

Drug-Drug/Food interactions:

31
Q

Zyprexa

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

olanzapine

32
Q

Seroquel

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-FDA approval for adjunctive therapy in major depressive disorder

Drug-Drug/Food interactions:

A

quetiapine

33
Q

Risperidal

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

risperidone

34
Q

Geodon

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

ziprasidone

35
Q

Latuda

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

lurasidone

36
Q

Saphris

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

asenapine

37
Q

Vraylar

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

cariprazine

38
Q

Symbyax

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

olanzapine + fluoxetine

Class:

Indications: bipolar depression

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

39
Q

Bipolar disease used to be called Manic Depressive disorder

A
40
Q

Bipolar 1 classification:
- At least one episode of ___________ and usually, bouts of intense depression (a depressive episode is not required for diagnosis)

  • ____________ is associated with at least one of the following: __________________
A

mania

mania

significant impairment in social/work functioning, *psychosis/delusions, or requires hospitalization.

41
Q

Define Mania:

What are the symptoms?

A
  • abnormally elevated or irritable mood for at least a week (or any duration if hospitalization is needed)

Symptoms:
- Inflated Self-esteem
- Needs less sleep “sleeping less”
- More talkative than normal
- Jumping from topic to topic
-Easily distracted
- Increase in goal-directed activity
- high risk, pleasurable activities (buying sprees, sexual indiscretions, gambling)

42
Q

Diagnostic criteria for Mania:

A
  • patient has abnormally ELEVATED or IRRITABLE mood for at least 1 week, (OR any duration if hospitalization is needed) AND patient
  • exhibits > or = 3 symptoms (if mood is only irritable, then exhibits > or = 4 symptoms)
43
Q

Bipolar 2 classification:
- At least one episode of ________ (lasting > or = 4 consecutive days) and at least one depressive episode (lasting > or = 2 weeks)

  • ___________ does NOT affect social/work functioning, does NOT cause psychosis and does NOT require hospitalization.
  • does NOT have _________
A

hypomania

hypomania

mania

44
Q

Define Psychosis:

A

Severe mental condition where there is a loss of contact with reality, involves abnormal thinking and perception (hallucinations and delusions)

Hallucinations: sensing something that is NOT present. (ex. Imaginary voices, Jacob with girl communicating telepathically)

Delusions: a belief about something real that is not true. (ex. imagining that your family (which is real) wishes to hurt you.)
(Jacob- hearing his brothers saying hurtful mean things)

45
Q

-
-
-
-
-
-

A
  • symptoms of toxicity: nausea or diarrhea, slurred speech, or feel shaky and confused
  • Take with food or at end of meal to reduce nausea
  • maintain consistent salt intake. Changes in salt intake can alter lithium levels in the body (Na & Li inverse relationship)
  • maintain adequate hydration with non-caffeinated fluids
  • Avoid dehydration (excessive sweating, diarrhea, vomiting and prolonged heat/sun exposure). Can increase lithium levels and side effects.
  • Avoid in pregnancy/breastfeeding
  • Notify healthcare provider immediately for worsening nausea and diarrhea, slurred speech or confusion
  • Can impair alertness, use caution while driving or during other tasks requiring you to be alert.

Notes/Facts/Brand vs Generics part 3 (19 decks)

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