4 - Bipolar Disorder Flashcards Preview

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Flashcards in 4 - Bipolar Disorder Deck (16):
1

Bipolar 1

more mania

2

Bipolar 2

more depression

3

Pharmacological for Mania:
If on antidepressant, what do you do?

discontinue antidepressant immediately!

4

Pharmacological for Mania:
What are 1st line agents?

lithium, divalproex, SGA

5

Pharmacological for Mania:
If they're already on a 1st line agent (lithium, divalproex, SGA) what do you do?

dose adjustments can be made after checking blood levels where appropriate, or add on another medication

6

Pharmacological for Mania:
Can you start 2 of the 1st line agents at once?

yes - but only for severe cases

7

Pharmacological for Mania:
How long do you monitor for efficacy?

2 weeks at therapeutic dose before assessing need for change

8

Lithium conc for mania?

0.8-1.0 mmol/L

9

Lithium conc for maintenance?

0.6-0.8 mmol/L

10

Pharmacological for Depression:
What do you do for an unmedicated patient?

NOT AN ANTIDEPRESSANT - bc it can provoke mania

-lithium
-lamotrigine
-lurasidone
-quetiapine
*these can all be used as monotherapy

*if severe, start on 2 agents

11

Pharmacological for Depression:
How long do you treat for before assessing efficacy?

2-4 weeks

12

Pharmacological for Depression:
Which antidepressants have limited ability to provoke mania?

SSRIs and bupropion

13

Maintenance Therapy:
How long do you have to have no or minimum symptoms to be considered in "remission" ?

2 months

14

Maintenance Therapy:
gold standard?

lithium

15

Maintenance Therapy:
What are some talking points about lithium ?

-ppl need to maintain usual salt and caffeine intake and monitor fluid intake and output
-NSAIDs, ACEi, ARB, and diuretics increase lithium levels
-caffeine decreases lithium levels

16

Maintenance Therapy:
What are other options beside lithium ?

-antipsychotics (preferably SGA)
-mood stabilizers

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