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Exam 6 > Bipolar > Flashcards

Bipolar Flashcards

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1
Q

Prevalence of bipolar 1 vs bipolar 2

A

0.2% vs 0.4%

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2
Q

bipolar symptom severity score depression vs mania

A

90% vs 70%.

depression impacts people’s lives mroe

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3
Q

bipolar and schizophrenia all cause mortality rate has been going ____ and all cause hazard ratio ____

A

down, up

less likely to die but an danger risk went up

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4
Q

Bipolar disorder is ___ times more likely to die by suicide.
Bipolar type 2 is (greater/lesser) than bipolar 1 to die by suicide

A

20-30

greater

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5
Q

bipolar is dependent on having a _____ state and a _____ state

A

depressive, mania

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6
Q

Unipolar depressive duration and timing

A

6-12 month length

occur every 3-5 years

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7
Q

Bipolar depression duration and timing

A

Depressive episode length 3-6 months
acute manic episode length 2-4
occur yearly, could have 4 episodes a year

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8
Q

Mania definition (how many days, what is pt like)

A

7 day increased mood, irritability, energy or it requires hospitalization

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9
Q

DIG FAST criteria for mania episodes (bipolar 1)

A

Distractibility, Irresponsibility, Grandiosity (inflated self esteem), Flight of ideas, Activity/Agitation (increased goal), Sleep no need, Talkative/pressure speech

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10
Q

Hypomanic state- definitive of bipolar 2

A

4 consecutive days with elevated mood and energy. (unlike bipolar 1 where the person will cause problems in their life but bipolar 2 could have a hypomanic state that is productive and helpful)

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11
Q

SIG E CAPS

depressive episodes

A

Sadness, interest, guilt, energy, concentration, appetite, psychomotor retardation, suicidal thinking

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12
Q

Differences between Bipolar 1 and 2

A

1 week vs 4 days
hospitalization vs DIGFAST X4 if just irritable
marked impairment vs functional mania

both have expansive, irritability or abnormally increased energy

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13
Q

Age of onset for BPD

A

mean age is 18 years

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14
Q

Disruptive mood dysregulation disorder definition

A

impair in functioning, >3 outbursts/week. chronic irritability
increase risk for anxiety and unipolar depression.
Unlike bipolar, its episodic and develop mania

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15
Q

Family history for BPD

A

60-80%. concordance for monozygotic twins is 40-45%

really high odds ratio for BPD (24.47)

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16
Q

Other things on the differential for someone with BPD

A

MDD, Schizo, schizoaffective, adhd (no affective), borderline (hard time maintaining relationships), SUD, prednisone

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17
Q

BPD treatments always

A

mood stabilizer/ second messenger modifier

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18
Q

Lithium as treatment for BPD benefits, risks

A

Benefits: effective for all phases (depression, mania, maintenance), disease modifying (decreases suicidality)
Risks: tremor, hypothyroid, CKD/ESRD (kidney), epstein anomaly, toxic

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19
Q

What is ebstein’s anomaly

A

atrialization of right ventricle: RA invades space of normal RV

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20
Q

Difference in resolving an acute mania vs depressive episode?

A

mania-> lots of meds, can be resolved more quickly. poly pharmacy is the way
depressive-> takes longer to resolve and need to watch the patient

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21
Q

_________ has the highest comorbidity with SUD (used as a coping mechanism)

A

Bipolar. must stabilize these patients in the clinic-> if not there might relapse

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22
Q

First step to treating bipolar is _______ previously prescribed mood stabilizer or initiate new 2 or 3 drug combinations (_____, _______, ______)
PLUS ______ or ______ (as needed)

A

optimize
lithium, valproate, SGA
benzodiazepine, antipsychotic-> pull these away as the mania resolves

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23
Q

Second step to treat bipolar is combining ____ drugs

Third step is ____

A

3 (lithium plus anticonvulsant plus antipsychotic or 2 antipsychotic and not lithium)
ECT

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24
Q

DO NOT USE _______ TO TREAT BIPOLAR DEPRESSION

The preferred treatment is

A

SSRIs (antidepressants)

lithium or atypical antipsychotics (quetiapine, lurasidone)

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25
The true mood stabilizing medication is ______. This will help both acute mania and depression
Lithium. long term prevention of manic or depressive episodes
26
Valproic acid (depakote) and carbamazepine are best to treat _______ in bipolar disorder.
actue mania. | It will help prevent manic episode recurrence. Carbamazepine reserved for patients not responding to other meds
27
Lamotrigine is most beneficial for _____________ in bipolar disorders
preventing depressive episode recurrence. usually combined with another medication
28
For BPD, atypical antipsychotics such as ______, ______, ______ are used for acute mania and maintenance ??? check this slide 7
Quetiapine (Seroquel), lurasidone (Latuda), cariprazine (Vraylar)
29
Antidepressants, if used for BPD, should be used _________
in combination with mood stabilizers or antipsychotics. | risk of manic switch
30
sufficient treatment trial is _____ for BPD treatments
2 weeks. partial response -> push dose | continue therapy for 1 year. take away meds in a chronic setting.
31
Lithium mechanism potentially is through signal transduction cascades through inhibition of ______
glycogen synthase kinase 3
32
______ is a monovalent cation is rapidly absorbed, widely distributed, not protein bound, not liver metabolized, excreted unchanged in liver
lithium | easy to move Li intracellular, limited ways to get it out
33
Lithium is dependent on ____ for elimination
kidneys. filtered by flomerulus
34
___% of lithium is reabsorbed in kidneys. Same spot as ___ so if those levels go down-> higher Li reabsorption
80 | Na
35
Lithium has a ____ therapeutic index
NARROW (0.6-1mEq/L-> need to keep it here not in the lab reference range) must monitor if new medication is added
36
Li has a ___ hour half life. first steady state will be on day __
24 hour. day 6 | Obtain Li level if suspect toxic, drug drug interaction, change in renal fxn or Na change
37
What is the basic workup to be able to prescribe lithium
``` BMP (check Na and renal fxn) CBC + differential (causes leukocytosis) EKG Thyroid fxn Pregnancy Weight ```
38
Giving lithium with ____ can reduce AEs
food
39
Early AEs with lithium include ______ and _______ which might diminish overtime. There can also be ____ and lethargy.
``` Polydipsia and polyuria (get BMPs) Muscle weakness (also diminish with time) ```
40
_______________ is an AE for Li that occurs mostly during first weeks of treatment. it an be treated with a lower dose, nightly Li, or add a ____
Benign fine hand tremor | β blocker
41
Nausea is another AE of Lithium that is seen more with __________ and can be resolved with _______ or ________
immediate release Li at peak onset. | give Lit with food or sustained release
42
Diarrhea is another AE of Lithium that is seen more with __________ and can be resolved with _______
sustained release Li | Immediate release Li
43
Nephrogenic Diabetes Insipidus is a late adverse effect of lithium. Li decreases sensitivity of ______ response at ______ in kidney Pt: "I'm peeing a lot"
Antidiuretic hormone (ADH) V2 receptors Kidneys are unable to concentrate urine-> decrease absorption of fluid-> excrete fluid-> hypernatremia
44
Treatment for nephrogenic diabetes insidious includes _______, ______, ______
amiloride (midamor) -> ups V2 response. keep Li same bc blocks Li resorption decrease Li discontinue Li
45
Decrease in renal function is something seen in chronic Li treatment and __________ should be done
get a BMP, monitor Li, may need to decrease Li overtime
46
Hypothyroidism can happen from Li because it _____________ | As treatment start ________ (medication) and check TSH
inhibits thyroid hormone synthesis and release levothyroxine do not stop lithium
47
Anything that ________ or affects ________ can lead to increase Li levels-> Li toxicity
decreases renal function, affects Na/water balance
48
Dehydration and periods of vomitting and diarrhea can lead to Li toxicity because
need to keep fluids consistent.
49
Fine hand tremor becomes course hand tremor at Li levels ____. Other things at this level are
>2mEq/L | worsening GI, urinary incontinence, unstable gait, slurred speech, poor concentration, drowsiness, apathy
50
When someone has Li toxicity, what is the treatment plan
hold Li, give fluids, check serial Li levels | Li is dialyzable. (check again 8 hours later bc redistributed)
51
Li is pregnancy category ___, with_____ being a malformation seen. _________ is discouraged
D. worst risk is 1st try. causes ebstein's anomaly (tricuspid value malformation) Breastfeeding
52
Mechanism of Depakote is
inhibit voltage sensitive Na channels-> diminish excitatory-> potentiate gaba
53
Depakote has a ____ therapeutic index. dosed based on ___
wide (50-125mcg/ml). weight | used for acute mania
54
Depakote is metabolized through _______. | Protein binding is ______
glucuronidation | high
55
AEs of depakote is _________ and _______
hepatotoxicity and thrombocytopenia. get LFTs and CBC
56
Depakote is pregnancy category __
X
57
Carbamazepine induces ________ so need to check dosage 3 weeks after starting
its own metaolism
58
Carbamazepine is pregnancy category ___. Highest risk of ______, which can be supplemented with folic acid
D | neural tube defects
59
Carbamazepine has a _____ therapeutic index
narrow, 4-12 mcg/mL
60
Lamotrigine is metabolized by _____. It has _____ drug-drug interactions
glucuronidation | few
61
Most prominent AE from lamotrigine is _____ and best way to reduce it is _____
SJS, toxic epidermal necrolysis. | slow dose titration
62
______ increases lamotrigine levels due to lamotrigine's clearance-> increased risk of ____
depakote, SJS
63
Lamotrigine is pregnancy category ___
C
64
Carbamazepine adverse effects include:
D's (diplopia, dizziness, drowsiness, GI discomfort, blood dycrasias) SJS Hepatotoxcitiy, hyponatremia Osteomalacia-> monitor vita and Ca+
65
Atypical antipsychotics can be used as ______ for mania, but they can also be used in combo with _____
monotherapy | Li, Depakote, carbamazepine (early symptom relief then could discontinue, some could take a week to work)
66
Atypical antipsychotics are pregnancy category ___
C
67
The atypical antipsychotics that are FDA approved for acute bipolar depression + maintenance are
quetiapine, lurasidone, cariprazine, olanzapine-fluozetine

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