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Bipolar Flashcards

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1
Q

What is considered Bipolar 1?

A

Mania of at least 1 week. DOES NOT need to have depressive episode

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2
Q

What is considered bipolar 2?

A

hypomania <4 days and needs depressive episode

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3
Q

What gender gets more manic episodes?

A

men

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4
Q

WHat are some risk factors for bipolar?

A

stress, trauma, substance abuse, having a first degree relative, depression, thyroid

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5
Q

What medications are good to know that can cause mania?

A

alcohol, weed, antidepressants, stimulants (dopamine), steroids, thyroid

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6
Q

How does bipolar usually present as?

A

depression

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7
Q

What is the kindling theory?

A

more episodes= vulnerable for more

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8
Q

What can happen if bipolar is not treated?

A

increasing impairment and deficits of brain

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9
Q

What must you always assess in each bipolar counsel?

A

SUICIDE RISK

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10
Q

What is criteria of mania?

A

Not due to other meds
3 of: grandiosity, no sleep, racing thoughts, talking, distracted, agitation, high risk behaviours.

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11
Q

What is criteria of depression?

A

5 of:
S-sleep
I-change in interest
G-guilt
E- energy
C-concentration
A-appetite
P-psychomotor disturbances
S- suicidal ideation

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12
Q

What depressants are worse for causing mania?

A

TCA
SNRI
SSRI
Mirtazapine

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13
Q

How long to see improvement of mania and depression?

A

Mania- 1-2 weeks- full is 3-4
Depression- 2-4 MAYBE LONGER

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14
Q

If a person is on lithium and is experiencing peak tremors, how can we fix it?

A

extended release

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15
Q

How is lithium excreted?

A

renal

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16
Q

What can decrease lithium clearance?

A

low salt, low water, renal disease, NSAID, ACE, diuretics

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17
Q

What is range of lithium for acute, maintenance, and elderly mania?

A

Acute- 1-1.2
Maintenance- 0.6-1
Elderly- 0.6-0.8

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18
Q

What level can induce toxic lithium levels?

A

> 1.2

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19
Q

What are signs of toxic lithium?

A

drowsy, ataxia, tremor, seizure arrythmia

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20
Q

When should you take lab work for lithium?

A

12 hours after dose
5-7 days after starting

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21
Q

What can we do if nausea from lithium?

A

divide dose

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22
Q

What happens if you are toxic on lithium?

A

if not dangerous then hold dose and retest after 24 hours

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23
Q

Common side effects of lithium?

A

thirst, peeing, tremor, drowsy, weight gain, nausea

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24
Q

If a patient is 20 yrs old and female and is given a lithium prescription what MUST you do?

A

birth control

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25
What is divalproex?
prodrug of valproic acid
26
How does valproic acid work?
sodium channel inhibition and Increase GABA
27
In regards to PK and valproic acid what is good to know?
VERY protein bound= displacement interactions, hepatic
28
What is levels for valproic acid?
Not routinely done
29
If a person is in renal failure what is the dosing adjustment for valproic acid?
NONE :)
30
What interaction is high with valproic acid?
CYP2C9
31
What drugs are of high importance of increasing valproic acid levels?
Macrolides (mycins) salicylates
32
What drugs are of high importance of decreasing valproic acid levels?
carbapenems
33
What drug increases (how much) from valproic acid and can be life threatening?
50 % increase Lamotrigine- SJS
34
When is divalproex a good choice for mania?
if irritable or AUD
35
What monitoring is needed for valproic acid?
CBC, electrolytes, LFT, RASH
36
S/e of valproic acid?
NDV constipation, sedation, weight, rash, hepatotoxic, AMMONIUM
37
A patient comes in with a prescription for valproic acid. She is 23 and married.
TERATOGENIC
38
What is lamotrigine used for?
DEPRESSION ONLY
39
How does lamotrigine work?
sodium and glutamate inhibitor some serotonin
40
What is the therapeutic range for lamotrigine?
NONE
41
What drugs can induce metabolism of it?
phenytoin and CMZ
42
WHat is a good counselling tip for rash of lamotrigine?
no new lotions, detergents
43
In regards of titration of lamotrigine, how do we do it and why?
VERY slow due to SJS and TENS
44
What labs are needed for lamotrigine?
renal and hepatic
45
A 23 year old girl comes in with a lamotrigine prescription, what are we concerned about and why?
birth control- estrogen decreases lamotrigine
46
What do you do if you missed your meds of lamotrigine for 5 plus days?
NEW TITRATION
47
Why don't we like CBZ?
drug interactions
48
When would CBZ be an interesting option for patients?
if neuropathic pain/ trigeminal neuralgia
49
How does CBZ work?
sodium channel inhibition and other
50
WHat hormone does CBZ influence in the body? (NOT neurology)
ADH- resorb more water
51
What is unique to CBZ regarding metabolism?
induces its own hepatic metabolism
52
When is steady state in CBZ?
5 weeks
53
In regards to CBZ most common s/e, what can we do?
if nausea then take with food and divided doses
54
A patient comes in with a new prescription of CBZ. What should be checked?
INTERACTIONS
55
Common drugs that increase CBZ?
macrolides, VA, diltiazem, verapamil, AZOLES, grapefruit
56
What drugs are an issue to be on if also on CBZ?
DOACS and warfarin
57
S/E of CBZ?
Gi, CNS depression, hyponatremia, low WBC, rash
58
What genotype in caucasian and asian increases chance of rash in CBZ?
Caucasian- HLA-A3101 Asian- HLA-B1502`
59
Who can't take CBZ?
liver disease, low WBC, clozapine, CVD (HR and conduction issues)
60
A theme among bipolar medications is the use of BC. What is special for CBZ
NO ESTROGEN ONES
61
What supplementation should be done with CBZ?
vit D and calcium
62
Which is better atypical antipsychotics or regular?
atypical because less EPS (movement disorders)
63
What are typical side effects of atypical antipsychotics?
anticholinergic, EPS, sex dysfunction
64
What are some atypical antipsychotics?
risperidone, lurasidone, aripiprazole, quetiapine
65
Which is more effective for bipolar depression, mood stabilizer or combo with antidepressant?
Both he same
66
What is an issue with the study that looked at combo of lithium and antidepressant for depression?
only 8 weeks long
67
If a person is on combo therapy for bipolar and enters a manic state, as a pharmacist what should you do?
taper off antidepressant
68
Which SSRI is NOT recommended in bipolar?
paroxetine
69
Should a person be on long term antidepressants if bipolar?
no, once stable for 3-4 months taper off
70
What is first line for acute mania?
lithium, quetiapine, divalproex, aripipirazole and risperidone
71
Is combo with mood stabilizer and antipsychotic more effective than mono for acute mania?
yes- use when need fast recovery
72
When is lithium more preferred for acute mania?
classic euphoria, low number of episodes and family history of it working
73
When is divalproex more preferred for acute mania?
equally effective in classic and dysphoric mania, better if multiple episodes, irritable or comorbid substance use
74
If no improvement for acute mania is it better to add or switch? and when can we assume no improvements?
after 2 weeks, either or
75
Which agents DO NOT work for acute mania?
gabapentin, lamotrigine, topiramate, and omega 3
76
What is first line for bipolar depression?
Quietiapine, lurasidone and lithium, lithium, lamotrigine
77
In regards to evidence for bipolar depression which agent is better quetiapine or lithium?
quetiapine
78
Which agents are NOT recommended for bipolar depression?
ANTIDEPRESSANTS
79
If bipolar depression and weight gain is an issue which agent would you hold off on and which agent would you start if good coverage?
don't use quetiapine and use lurasidone
80
Is lithium or valproic acid better for maintenance of bipolar?
lithium
81
Is a combo of VA and lithium worth it?
yes -significantly
82
If acute phase meds work what should we use for maintenance?
SAME ONES
83
If you have mixed episode bipolar (switch rapidly or both), what agents to use?
atypical antipsychotics
84
Which agent to use in pregnant bipolar patients?
lamotrigine safe neutral agents are quetiapine, risperidone, aripiprazole
85
If patient is suicidal and is taking lithium what should we don in regards to the medication itself?
don't give a month as overdose is fatal
86
Which agent has the most evidence for prevent suicide in bipolar patients?
lithium
87
What agents do not appear to have no effect on suicide risk in bipolar patients?
antipsychotics

pharmacy 358 (16 decks)

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