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Therapeutics P3 Fall > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

Bipolar 1

A

Manic episode +/- major depressive or hypomanic episodes

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2
Q

Bipolar 2

A

Major depressive episode + hypomanic episode

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3
Q

Bipolar Sx/Risk Factors

A

<25 yo
family hx
increased sleep + appetite
psychomotor retardation
atypical depression
Co-occurring substance abuse

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4
Q

4 A’s of Atypical Depression

A

Anxious
Anger
Agitation
Lack of Attention

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5
Q

Rapid cycling

A

More than 4 episodes per year

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6
Q

Dysthymia

A

persistent depressive disorder (mild but long term depression)

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7
Q

Cyclothymia

A

cycle of ups and downs similar to bipolar disorder but more mild

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8
Q

Schizoaffective disorder

A

mix of schizophrenia with mode episodes of bipolar disorder
treatment:
-mood stabilizers + APS (Paliperidone, Clozapine)

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9
Q

Drugs 1st line drugs FDA approved for Acute Mania & Mixed Episodes

A

Lithium**

AED:
-Valproate**
-Carbamazepine ER + IR

SGA:
-Quetiapine**
-Aripiprazole*
-Asenapine*
-Cariprazine*
-Olanzapine*
-Risperidone*
-Ziprasidone

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10
Q

Drugs 1st line drugs FDA approved for Maintenance Therapy

A

Lithium

AEDs:
-Valproic Acid
-Lamotrigine

SGAs:
-Aripiprazole
-Olanzapine
-Quetiapine
-Risperidone
-Ziprasidone (adjunct to Li/VPA)

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11
Q

Drugs 1st line drugs FDA approved for Acute Depression

A

Lithium

AEDs:
-Lamotrigine (BP II only)
-Cariprazine (Vraylar)

SGAs:
-Lurasidone (Latuda)
-Olanzapine w/ fluoxetine (BP II only)
-Quetiapine (Seroquel)

Antidepressants can be used but not as monotherapy (SNRI better than TCA)

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12
Q

Drugs for treatment of Agitation in Bipolar Disorder

A

Aripiprazole
Lorazepam
Loxapine
Olanzapine

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13
Q

Meds NOT recommended in acute mania

A

gabapentin
topiramate
lamotrigine
verapamil
tiagabine
risperidone + carbamazepine
olanzapine + carbamazepine

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14
Q

Meds NOT to use in depressive episodes

A

gabapentin
aripiprazole
ziprasidone
adjunct levetiracetam (Keppra)

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15
Q

Meds NOT to use in maintenance

A

gabapentin
topiramate
antidepressants
adjunct fluphenthixol

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16
Q

Lithium dosing

A

900mg - 2400mg /day in 2-4 div doses
take with food

17
Q

Target lithium serum concentration

A

0.6-1.2 mEq/L

18
Q

Toxic lithium serum concentration

A

> 1.5 mEq/L

19
Q

When is the best time to perform TDM for lithium concentrations

A

at trough:
8-12 hrs after last dose
5 days after stable dose is achieved
may draw sooner if toxicity or nonadherence concerns

20
Q

Lithium ADE

A
  • nephrotoxicity (Polydipsia and polyuria +/- nephrogenic diabetes insipidus) -> can have irreversible consequences
  • AKI, CKD
  • GI and CNS (dose related, worst at peak)
  • muscle weakness and lethargy
  • CV events
  • hypothyroidism
  • floppy baby syndrome
21
Q

Lithium ADE: Management of GI and CNS effects

A

lowest effective dose
once daily dosing (XL) at bedtime
take with food
liquid formulation for diarrhea

22
Q

Lithium ADE: Tremor management

A

long acting preparations
lower dose
add beta blocker (propranolol)

23
Q

Valproate ADE

A

Dose related:
- GI (transient)
-Tremor (dose decrease / BB)
- Sedation (HS dosing)

Prolonged bleeding
Weight gain
Hyperammonemia
Alopecia (dose dependent)
BBW: pancreatitis and/or hepatotoxicity, urea disorders

24
Q

Lamotrigine ADE

A

SJS
aseptic meningitis
prodrome chills
sore throat
fever

25
Q

Carbamazepine ADE

A

Neutropenia
Leukopenia
Hematologic disease
Agranulocytosis
Porphyria
Hyponatremia
decreased ADH release

Warning Asian HLA-B 1502 patients at increased risk of SJS

26
Q

Long acting injections approved for bipolar disorder

A

Aripiprazole (Abilify Maintena)
Risperidone (Risperdal Consta)

27
Q

Which medication appears to be the most favorable for treating bipolar disorder in pregnant patients

A

Lamotrigine

28
Q

Aripiprazole ADE

A
  • IMPULSIVITY
    -little weight gain
    -insomnia
    -akathisia
    -restlessness
29
Q

Quetiapine (Seroquel) ADE

A

-sedation
-metabolic issues
-QTc prolongation
-anticholinergic effects
-cataracts

30
Q

Asenapine (Saphris) ADE

A

-among the least sedating and anticholinergic of SGAs
-QTc prolongation
-anaphylaxis
-skin irritation with topical patch

31
Q

Cariprazine (Vraylar) ADE

A
  • akathisia
32
Q

Olanzapine (Zyprexa) ADE

A
  • Metabolic Risks
  • DRESS
  • post injection delirium / sedation syndrome
  • QTc prolongation
33
Q

Risperidone (Risperdal) ADE

A

-EPS
-Prolactin (gynecomastia, abnormal menses etc.)

34
Q

Lurasidone (Latuda) ADE

A
  • less notable weight gain, sedation, and orthostasis compared to other SGAs
  • do not use with strong CYP3A4 inhib/inducer

Therapeutics P3 Fall (21 decks)

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