Bi-Polar Meds

Question 1

What medications may cause mania?

Answer 1

L- dopa and corticosteroids

Question 2

In general with bipolar disorder what 5 things should you do before prescribing medication?

Answer 2

Asses if there is a drug/alcohol problem

D/c anti depressants

taper caffeine/stimulants

treat substance abuse

encourage diet and exercise

Question 3

What drug might you chose to treat hypomania initially (4)

Answer 3

Lithium, valproate, carbamazepine, SGAs

Question 4

If mono therapy is inadequate in treating hypomania what combonation drugs might you try?

Answer 4

Lithium + anticonvulsant or SGA

Anticonvolsant + SGA

Question 5

What is an alternative for benzos when treating agitation?

Answer 5

oxcarbazepine

Question 6

What drugs could you use to first treat mania?

Answer 6

Lithium, valproate and/or SGA and benzos

Question 7

What is lorazepam especially indicated for?

Answer 7

Catatonia

Question 8

How many drugs should you initially start off with in patients who have mania?

Answer 8

2-3

Question 9

What is an alternative med in treating mania?

Answer 9

carbamazepine or oxcarbazepine

Question 10

If lithium, valproate and or benzos/SGA do not work to treat mania what can be used?

Answer 10

Lithium + antipsychotic + anticonvulsant

Anticonvulsant + anticonvulsant + antipsychotic

Question 11

What can be used in the most resistant cases of mania?

Answer 11

clozapine or ECT

Question 12

What is preferred over valproate for treating bipolar depression?

Answer 12

lithium + lamotragine

Question 13

What is the drug of choice for mania?

Answer 13

lihtium

Question 14

What are the only approved mono therapies for bipolar disorder?

Answer 14

quetiapine- seroquel and lurasidone-latuda

Question 15

How long to anti depressants take to star working with bipolar?

Answer 15

6-8 wks

Question 16

What is lithiums half life and maintenance levels in blod?

Answer 16

0.6-1

24 hour half life

Question 17

What are the potential side effects for lithium?

Answer 17

rash/psoriasis

tremor/akathesia

hypothyroidisn

teratogenicity

Question 18

What drugs does lithium interact with to decrease concentration?

Answer 18

Pregnancy and theophylline

Question 19

What 3 main categories increase lithium concentrations?

Answer 19

ACEI, ARBS, NSIADS by decreasing kidney function

Question 20

What tests should be performed pre-lithium initiation and every 6 mos

Answer 20

pre :
CBC, BMP, TSH, urinalysis

6mo:
Serum Li, renal function, thyroid function

Question 21

What 3 anticonvulsants can be used to treat bi-polar disorder?

Answer 21

divalproex - depacon(IV)
valproic acid - Depakote

Carbamazepin(Tegretol

Lamotrigine ( Lamictal)

Question 22

How does divalproex work?

S/e

Answer 22

increases GABA available

great for mania, not so much depressive episodes

S/e: wt gain, hair loss, tremor “fat bald and shaky”
hepatotoxic and teratogenic

Question 23

What drug does valproic acid have an interaction with?

Answer 23

lamotrigine - competes for gluconoridation so you need to decrease lamotrigine by 50%

Question 24

When does carbamazepine work exceptionally well?

Answer 24

Head injuries for acute and maintenance biolar

Question 25

What is the most drastic side effect with carbamazepine along with the other 2 side effects?

Answer 25

Steven johnson syndrome in Asain ancestry with HLA B gene SIADH agranulocytosis and liver failure

Question 26

What type of inducer is carbamazepine? What does that mean?

Answer 26

CYP3A4 AUTOinduer... it induces itself so you progressively have to increase the dose

Question 27

What drug is structurally related to carbamazepine?

Answer 27

oxcarbazepine

Question 28

What is the MOA of lamotrigine? What pts does it work best in? S/e?

Answer 28

MOA: inhibit glutamate transmission Works best in depressive bipolar bc glutamate is left in synapse Steven Johnson Syndrome

Question 29

What drug interactions does lamotrigine have? how do you adjust for these TWO drug interactions?

Answer 29

valproic acid and carbamazepine valproic - decrease by 50% carbamazepine - increase by 50%

Question 30

What antipsychotic drugs should and should not be used with acute mania or mixed treatment?

Answer 30

all SGA can be used except: brexpiprazole cloxapine iloperidone

Question 31

What are the only two antipsychotic medications approved to treat bipolar depression?

Answer 31

quetiapine - seroquel lurasidone - latuda

Question 32

What should you never use as a mono therapy in bipolar patients due to the possibility of switching over to mania?

Answer 32

antidepressants

Question 33

What drug is significant in causing akathisia like tremors when treating bipolar disorder?

Answer 33

Lithium