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IDT Fall > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

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1
Q

why are bipolar meds considered “neuroprotective”?

A

during mania glutamate is released which increases intracellular calcium and cortisol which can damage nerve cells

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2
Q

name the list of drugs that can increase risk of mania in bipolar

A

-alcohol
-bronchodilators
-caffeine
-cocaine
-stimulants
-steroids
-antidepressants
-hallucinogens
-dopamine agonists
-pseudophedrine
-interferon

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3
Q

how to diagnose bipolar I?

A

previous manic or mixed features lasting at least 7 days or requiring hospitalization

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4
Q

what are the alternating symptoms of bipolar I?

A

full manic episodes alternate with full major depressive episodes

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5
Q

what are the alternative symptoms of bipolar II?

A

full major depressive episodes alternate with hypomanic episodes

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6
Q

T/F both BP I and II spend majority of life in a depressive state

A

True

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7
Q

what is leaden paralysis?

A

when you don’t want to get up or do anything

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8
Q

people with ADHD have a ____ chance of bipolar disorder

A

10-20%

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9
Q

people with anxiety have a ____ chance of bipolar disorder

A

35-50%

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10
Q

people with OCD have a ____ chance of bipolar disorder

A

12-20%

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11
Q

people with alcoholism have a ____ chance of bipolar disorder

A

60%

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12
Q

people with an eating disorder have a ____ chance of bipolar disorder

A

8-14%

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13
Q

which drug to treat bipolar has the most evidence for protecting against suicidality?

A

lithium

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14
Q

T/F people with atypical bipolar and bipolar with mixed features are more responsive to lithium than in classic bipolar

A

false, it’s the opposite

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15
Q

With bipolar, there is reduced grey matter volume in the _________ which impacts decision making and judgement

A

prefrontal cortical regions

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16
Q

elevated cortisol reduces ______ size and promotes stress hormones and glutamate neurotoxicity

A

hippocampal

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17
Q

why is misdiagnosis of depression a major concern in bipolar patients?

A

antidepressants trigger manic disorder

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18
Q

which two drugs are best for treating manic episodes?

A

divalproex and lithium

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19
Q

which drugs are used for bipolar depression?

A

lamotrigine
lithium
quetiapine
cariprazine
olanzapine/fluoxetine
lurasidone
lumateperone

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20
Q

which drugs are used for mania and mixed bipolar treatment

A

divalproex
carbamazepine
aripiprazole
ziprasidone
risperidone
asenapine
cariprazine
olanzapine

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21
Q

which drug is used for mania, mixed, and depression bipolar?

A

cariprazine

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22
Q

what are the SEs of lumateperone?

A

drowsiness, dizziness, dry mouth, and nausea

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23
Q

SEs of cariprazine?

A

drowsiness and sedation

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24
Q

what are the benefits of cariprazine? (lower risk of what SEs?)

A

low risk for EPS, weight gain, and metabolic SEs

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25
what is the downside of cariprazine? (time for full efficacy)
takes 2-3 months for full efficacy
26
what are the top drugs of choice as monotherapy for bipolar I?
lithium, valproic acid, aripiprazole, risperidone, ziprasidone, olanzapine, and quetiapine
27
adjunctive therapy (most common) for bipolar I is combinations of?
Lithium + valproic acid OR Lithium/valproic acid with quetiapine or risperidone or aripiprazole or ziprasidone
28
drugs for monotherapy for bipolar II?
lithium, lamotrigine, olanzapine/fluoxetine, lurasidone
29
adjunctive therapy for bipolar II?
lithium or valproic acid with lamotrigine or quetiapine or lurasidone or olanzapine or olanzapine/fluoxetine
30
T/F lithium is not effective in bipolar with mixed or atypical features as monotherapy
True
31
what's the best antipsych for children?
risperidone
32
T/F ADHD is the strongest predictor of poor lithium response in children
true
33
why is depakote ER and sprinkles a good choice for elderly with bipolar?
provides steadier serum levels with reduced peak level side effects
34
what is the best drug for pregnancy?
lurasidone
35
what is another good drug for pregnancy?
clozapine
36
which drugs should be avoided in 1st trimester and at delivery in pregnancy?
lithium lamotrigine valproic acid carbamazepine
37
which drug class should be avoided in pregnancy?
benzos
38
why do we not typically prescribe lamotrigine to individuals using oral contraceptives?
lowers lamotrigine levels by ~50%
39
why do we not prescribe carbamazepine to people using oral contraceptives?
it may decrease the oral contraceptives efficacy
40
what signs should a mother look for for infant toxicity of drugs passing through breast milk?
poor feeding jaundice rash sedation
41
what are the lithium adverse effects? (LITHIUM acronym)
Leukocytosis (incr WBC) Diabetes Insipidus/ polyuria Tremor Hypothyroidism Increased weight, edema Unwanted acne, alopecia (hair thinning/loss), dermatitis Memory impairment
42
what interaction is there b/w NSAIDs and lithium?
NSAIDs cause lithium toxicity, presenting as N/V, restlessness, and racing heart
43
what interaction is there b/w ACE-i/ARBs and lithium?
cause lithium toxicity
44
which "anti-inflammatory" agent is okay to take while on lithium?
aspirin
45
what interaction is there b/w diuretics and lithium?
cause lithium toxicity
46
what interaction is there b/w methylxanthines (like caffeine) and lithium?
can decrease lithium levels
47
what is the recommendation to patients taking lithium who consume a lot of caffeine?
don't abruptly decrease or increase caffeine intake
48
what is the maintenance range of plasma concentration of lithium?
0.6-1
49
what is the acute mania range of plasma concentration of lithium?
0.8-1.2
50
what is the elderly range of plasma concentration of lithium?
0.4-1
51
is a maintenance level of 1.1 plasma concentration of lithium concerning?
no, only if patient is showing signs of an adverse reaction
52
what are the warning signs of initial lithium toxicity (0.9-1.4)
fine hand tremor polyuria mild thirst
53
counseling points for lithium:
take with food to avoid nausea and stomach upset take at bedtime
54
what can pt do if they develop a mild tremor on lithium?
use beta blockers like atenolol and propranolol or a BZD
55
what can pt do if they have increased urination on lithium?
can add amiloride to treat it
56
T/F valproic acid is a safe alternative in pregnancy
false, do not use in pregnancy
57
what are the SEs of valproic acid?
weight gain, reduced platelets and WBCs, increased ammonia levels, and alopecia (hair loss)
58
why should aspirin not be used with valproic acid?
it increase valproic acid levels in body and can lead to higher ammonia levels
59
what is the treatment for hyperammonemic encephalopathy?
lactulose 30-45 ml every hour until a bowel movement, then q8-12 hrs for 5 days
60
list the drugs with interactions with valproic acid
lamotrigine, salicylates, carbapenem antibiotics, and warfarin
61
whats an adverse reaction to counsel on for lamotrigine?
stop use if a rash occurs and let prescriber know
62
what is the interaction b/w lamotrigine and estrogen products? what to do about interaction?
they reduce lamotrigine levels may need higher lamotrigine doses
63
what is the interaction b/w lamotrigine and valproic acid? what to do about interaction?
lamotrigine levels may increase and valproic acid levels may decrease lower dose of lamotrigine and possible higher dose of valproic acid
64
what is the interaction b/w lamotrigine and folic acid?
lamotrigine blocks folate metabolism
65
what's a helpful counseling point for a patient starting lamotrigine?
avoid using new soaps or skin products during lamotrigine titration
66
what 2 drugs would be most sedating if one wanted to quickly slow down a manic person threatening to cause harm?
quetiapine and valproate/depakote
67
which drug has the best overall evidence for reducing suicide risk and treating acute euphoric mania?
lithium
68
if someone had past history of cardiac myopathy or QT prolongation, which drugs should they not use?
ziprasidone risperidone quetiapine
69
which drug is the safest in pregnancy?
lurasidone
70
which 4 drugs are not monotherapy for mania symptoms?
lamotrigine olanzapine/fluoxetine lurasidone lumateperone
71
which 4 drugs are not monotherapy for mixed symptoms?
lithium queitapine lurasidone lumateperone

IDT Fall (29 decks)

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