Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Behavioral Medicine > Bipolar 3: Tx > Flashcards

Bipolar 3: Tx Flashcards

1
Q

Lithium carbonate uses (5)

A
  1. Bipolar Disorder
  2. Schizoaffective Disorder
  3. Augmentation in Major Depressive Disorder
  4. Impulse control disorders
  5. Aggression: Mental retardation, Personality disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lithium dosing

A
  • Goal: obtain 0.6-1.4 mEq/L (tiny Therapeutic window)
  • 300 mg bid or extended release qd

(maintenance serum level every three months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Lithium is successful and effective in treating bipolar disorder in ____% of cases

A

70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lithium: side effects (8)

A
  1. Thirst, polyuria, weight gain, edema (its a salt)
  2. Hypothyroidism
  3. Elevated calcium & parathyroid hormone
  4. Nonspecific T wave changes
  5. Worsen acne or psoriasis
  6. Leukocytosis
  7. PD-like symptoms
  8. Cognitive slowing

(May reduce the risk of melanoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Lithium is similar to ______ (element). Which conditionis associated with it’s use?

A
  • Iodine
  • Hypothyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you monitor hypothyroidism while treating bipolar disorder with lithium?

A

Monitor at Baseline and every 6 to 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lithium is excreted via ________

A

kidneys are reabsorbed in the proximal tubules with Na and water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hyponatremia will cause _____ in a patient who is treated with lithium.

A

lithium toxicity

(the kidneys will compensate by reabsorbing more sodium than normal in the proximal tubules, lithium is re-absorbed with it)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Long term use of lithium: renal side effect

A

Reduced glomerular filtration rate

(renal function should be assessed at baseline and every 6 to 12 months or after)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

_____ should be avoided in patients taking lithium

A

Sodium depleting diuretics (thiazides)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lithium toxicity is a medical emergency and is a blood level of ______

A

3 mM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Lithium toxicity symptoms (9)

A
  1. neuromuscular irritability or flaccidity
  2. dysarthria
  3. tremor
  4. ataxia
  5. renal failure
  6. confusion
  7. hallucinations
  8. seizures
  9. stupor

(Can cause permanent cerebellar ataxia, death)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lithium levels are at a peak _____ (time) after absorption

A

2 hours

(rapidly absorbed from the gut)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lithium half life (manic and euthymic patients)

A
  • Manic: 8-12 hours
  • Euthymic: 18-36 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Lithium metabolism (3)

A
  1. Kidneys (found in all bodily fluids)
  2. No protein-bound (easily crosses BBB)
  3. No metabolites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment for lithium toxicity

A

Dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lithium contraindications

A
  1. Renal disease
  2. MI (for 2 weeks)
  3. Myasthenia gravis
  4. Diabetes, ulcerative colitis, psoriasis
  5. Senile cataracts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lithium mechanism of action

A

Unknown but may be correlated with gene expression for growth factors and neuronal plasticity

(Inositol Depletion Hypothesis & Regulation of the Wnt and Glycogen Synthase Kinase 3 beta. GSK 3B is an important enzyme in pathways including the Wnt signaling cascade)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Lithium may cause ______ if use during the first trimester of pregnancy.

A

Ebstein’s anomaly

(heart develops in the first 6 weeks of gestation; you have to weigh the risks, the patient may be suicidal. Baby will also have effects from untreated bipolar- glucocorticoids, etc)

20
Q

Valproate uses

A
  1. Seizures
  2. Migraine headache
  3. Bipolar disorder
21
Q

Valproate is digested through the stomach and highly protein-bound. Half life _____

A

8-17 hours

(highly protein bound; rapidly reabsorbed)

22
Q

How often are valproate levels checked

A

Monthly until stable than every 6 months

(plasma levels 50 to 125 mcg/ml = response)

23
Q

Valproate side effects

A
  1. Vomiting
  2. Poor Appetite
  3. Liver Toxicity (Hepatic transaminase elevation)
  4. Retain fat (Weight gain)
  5. Tremor
  6. Sedation

(mnemonic: VALRT - VALpRoaTe)

(coma and death from overdose)

24
Q

Valproate black box warning:

A
  1. Hepatotoxicity
  2. Pancreatitis
  3. Teratogenicity (neural tube defects; mental retardation)
25
Q

Carbamazepine serum levels that correlate with effectiveness

A

8-12 mcg/ml

26
Q

Carbamazepine side effects:

A
  1. Rash
  2. Leukopenia
  3. impaired coordination, drowsiness, slurred speech, ataxia
27
Q

Carbamazepine black box warning

A
  1. Teratogenicity
  2. aplastic anemia and agranulocytosis
  3. Toxic epidermal necrolysis (SJS when >30% of the skin is effected)
28
Q

What is an advantage to Lamotrigine that you don’t find with other bipolar treatments?

A

You don’t need to check the blood levels

29
Q

Lamotrigine uses

A

Maintenance of bipolar treatment

30
Q

Lamotrigine MOA

A

Blocks Na+ channel → inhibits release of presynaptic glutamate aspartate and GABA

(possibly; mechanism unclear)

31
Q

Antidepressants in bipolar depression may have the following negative effects _____ (3).

A
  1. Depression to Mania
  2. Increase cycle frequency
  3. Convert condition to more malignant form
32
Q

Lamotrigine: pharmacokinetics

A

60% protein bound

33
Q

Lamotrogine side effects

A
  1. possible rash (slow titration reduces this risk)
  2. Steven-Johnson syndrome
  3. Teratogenicity: cleft lip

(Fewest side effects of all)

34
Q

Nonpharmacologic treatment for bipolar

A
  1. Psychotherapy
  2. Light therapy for depression (risk of mania and hypomania)
  3. Electroconvulsive therapy for Mania and depression
35
Q

Physician-patient interaction with manic patients : difficulties

A
  1. Pressured speech→ difficult to interview
  2. They think that they are fine
  3. Physician may feel angry fear or frustration
36
Q

How can you establish a common ground with a patient in a manic episode?

A

Psychophysiological symptoms

(i.e. “You haven’t sleep in 3 days, we need to do something about this.” They are less likely to respond to comments on their behavior)

37
Q

General First-line maintenance treatment: bipolar 1

A
  1. Mood stabilizing medication
  2. Reassess need for antipsychotic and antidepressants

(Discontinue antipsychotic (unless they have persistent psychosis))

38
Q

Why is it best to prevent episodes of bipolar disorder?

A

More than 4 episodes increases the risk of dementia, diabetes, heart disease

39
Q

Second-line maintenance treatment of bipolar disorder

A
  1. ECT (once per month)
  2. Individual or group psychotherapy
40
Q

General principles of bipolar disorder care (4)

A
  1. To the illness, not the episode
  2. Educate on destabilizing factors
  3. Use regimine they can stick to
  4. Acute episode drug needs are often different from maintenance needs
41
Q

Destabilizing factors for bipolar disorder

A
  1. Shift-work
  2. Not sleeping
  3. Substance use issues
42
Q

Why is compliance difficult for patients with bipolar disorder?

A
  1. Side effects
  2. They miss the high of mania (creativity and productivity)
  3. Dislike mood control by meds
  4. Denial of chronic illness
43
Q

Concomitant use of _____ have a potential to rise a lithium levels.

A

NSAIDs

(possibly through effect on renal prostaglandin synthesis or decreased )

44
Q

Oxcarbamazepine (trileptal) is also used to treat bipolar. Side effects are similar to carbamazepine but less risk of _____

A

anemia and agranulocytosis

45
Q

Which two drugs are not effective as mood stabilizers but may be helpful for anxiety in bipolar patients?

A
  1. Gabapentin (Neurontin)
  2. Regabalin (Lyrica):

(picmonic: The gabakusa penguin disguises itself as a Goose to infiltrate Caesars Zoo & punish Caesar for keeping animals captive)

46
Q

Which drug is not effective as a mood stabilizer but is used in PTSD and headaches?

A

Topiramate

(Weight loss is a common side effect)

47
Q

What do you do w/a patient who has parkinson’s disease and psychosis?

A

if you can’t adjust parkinson’s med → use loose-binding D2 antagonist

(Rx goes to all DA receptors, we can’t pecifically target them)

Behavioral Medicine (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions