Bipolar

Question 1

What is bipolar disorder?

Answer 1

• Fluctuatoins in mood from an extremely sad or hopelss state to an abnormally elevated, overexcited or irritable mood called mania

Question 2

What is bipolar I?

Answer 2

• at least one episode of mania
• Maina is associated with at least one of the following: impairment in social or work functions, psychosis/delusions, or hospitalization

Question 3

What is bipolar II?

Answer 3

• at least one episode of hypomania (lasting > 4 days) and at least one depressive episode
• This DOES NOT affect social/work, DOES NOT cause psychosis, NO hospitalization

Question 4

What are some of the symptoms of mania as described in the DSM-5 Diagnostic criteria?

Answer 4

• Inflated slef esteem
• Needs less sleep
• more talkative than normal
• jumping from topic to topic
• easily distracted
• increased in goal-directed activity
• high risk pleasurable activities

Question 5

what are some of the drug treatment options that are used for bipolar?

Goal is to stabilize the mood WITHOUT inducing a depressive or manic state

Answer 5

• Mood Stabilizers (Lithium) & Antiepileptics (Valproate, Lamotrigine, Carbamazepine) treat BOTH mania and depression
• Antipsychotics can help stabilize the mood when mania occurs
• Antidepressants can induce mania when given alone (should be used with Mood Stabilizers)

Question 6

What is the acute treatment for a manic episode?

Answer 6

• Antipsychotic (olanazpine, risperidone), lithuim or valproate

Antipsychotic + Lithium or Valproate for severe episodes

Question 7

What is the Acute treatment for a depressive episode?

Answer 7

• Antipsychotic (quetiapine, lurasidone).
• Lithium, Valproate or Lamotrigine can be added

Question 8

What medications should be used as maintenance after a manic/depressive episode?

Answer 8

• What helped the acute episode = helps prevent relapse
• i.e.; lithium, antiepileptics, 2nd gen antipsych

Antidepressants NEED a medguide = ALL have increased suicide risk

Question 9

What are the antepileptic drugs that are commonly used to help with bipolar disorders?

Answer 9

• Lamotrigine (Lamictal) [needs slow tiration to prevent rashes
• Valproate (Valproic Acid, Divalproex)
• Carbamazepine

Question 10

What are some of the 2nd generation antipsychotics that are commonly used to help with Bipolar disorders?

Answer 10

• Aripiprazole (Abilify)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Ziprasidone (Geodn)

Question 11

What is the MOA for lithium (lithobid)?

Answer 11

• Works to influence the reuptake of serotonin and/or noepi or by moderating glutamate levels in the brain (high levels could cause mania)

Question 12

What are some warings for lithium?

Answer 12

• Serotonin syndrome

Question 13

What are some within therapeutic range side effects for lithium?

Answer 13

• GI upset (N/D), cognitive effects, cogwheel rigidity, tremor, thirst, polyuria/polydipsia, wieght gain, hypothyroidism

Question 14

What are some toxicity side effects for lithium?

Answer 14

• > 1.5 mEq/L: ataxia, coarse hand tremor, vomiting
• > 2.5 mEq/L: CNS depression, arrhythmias, seizures, coma

Question 15

What are some things to monitor with lithium?

Answer 15

• Lithium levels, renal function, thyroid function

Question 16

What are some additional notes for lithium?

Answer 16

• Renally cleared
• Avoid in pregnancy