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Flashcards in Bipolar disorder Deck (30):
1

What drug classes are used in the treatment of bipolar D/O?

-Lithium
-Anticonvulsants
-Antipsychotics
-Benzos

2

What role do benzos have in bipolar tx?

Acute treatment of agitation, insomnia, or anxiety

3

What use does lithium have in bipolar disorder?

Treats acute mania, hypomania, mixed states, and bipolar/ unipolar depression

4

What PK information is important for lithium use?

-Rapidly absorbed PO route
-100% excreted in urine, must monitor renal function test

5

Intro dosing of lithium?

Start BID-TID w/ titrations every few days until therapeutic level reached

6

Dosage changes in lithium use post- therapeutic level?

Change dosing schedule to once daily if no ADRs

7

What are contraindications to the use of lithium?

-Significant renal impairment
-Sodium depletion
Dehydration
-Significant CV disease

8

What drugs have DDIs with lithium?

-Diuretics
-ACEIs
-CCBs
-TCN & Metronidazole
-NSAIDs

9

What are acute ADRs of lithium?

-Nausea
-Weight gain
-Cognitive impairment
-Polyuria/polydipsia
-Loose stools

10

What are chronic ADRs of lithium use?

-Renal function
-Thyroid function
-Parathyroid function
-Rarely cardiac dysrhythmias

11

What tests must be performed at baseline before starting llithium use?

-Urinanalysis
-Bun/Cr
-Thyroid
-Pregnancy (if child bearing potential)

12

What is important in regards to lithium toxicity?

Narrow therapeutic window, correlate serum levels w/ timing of last dose since serum level may not correlate /w peak concentration

13

What signs/ sx are associated with lithium toxicity?

-GI: N/V/D
-Neurologic: confusion/agitation, ataxia; SEVERE- seizures, encephalopathy
-Cardiax (rare): arrythmias, bradycardia

14

If a patient is suspected to be experiencing lithium toxicity what do you do?

-Treat symptomatic patient even if serum concentrations low
-Treat high labs even if patient is asymptomatic

15

What is recommended treatment of lithium toxicity?

-Stop lithium, ABCs
-Supportive care/ hydration
-GI decontamination w/ whole bowel irrigation with PEG

16

What medications are C/I for bipolar disorder?

Antidepressants

17

What factors would rank a bipolar patient as 'severe'?

-Suicidal/ homicidal
-Aggressiveness
-Psychotic features
-Poor judgment that places self/others in harm

18

How is a severe bi polar patient be managed?

Inpatient

19

What drug regiment is preferred for a severe bipolar patient w/ mania?

Lithium/ valproate with an antipsychotic (Haloperidoal, Aripiprazole, Olanzapine, Quetiapine, Risperidone)

20

How is a severe bipolar patient (mania) managed if they show resistance/ no response over 2 weeks?

Switch between Lithium and Valproate by cross-taper over 2 weeks

21

If changing Valproate/Lithium doesn't have an effect over cross-taper to control mania how proceed?

Change antipsychotic

22

How is mania managed in a mild-moderate bipolar patient managed?

Outpatient

23

What type of medication therapy is a patient w/ mild-moderate manic bipolar patient treated with?

Monotherapy; Risperidone or Olanzapine (efficacy and tolerability)

24

How to treat manic bipolar in pregnancy? List first line, resistant, and refractory

-Haloperidol (other FGAs)
-Risperidone or Olanzapine
-Lithium or ECT

25

How is Bipolar mania treated in geriatric patients? 1st line and 2nd line

-Olanzapine or Quetiapine
- Combo tx, add lithium/valproate to 1st line med

26

How is acute bipolar depression treated pharmalogically?

Monotherapy
-Lamotrigine/ Olanzapine
-Lithium

27

How is bipolar depression managed in pregnant patients? 1st line, resistant, refractory

-Lamotrigine
-Quetiapine
-Fluoxetine + Olanzapine

28

How is bipolar depression treated in geriatric patients? 1st line, resistant, refractory

-Quetiapine
-Lamotrigine or combo
-ECT

29

How is maintenance therapy managed in bipolar patients?

1st line: same regimen that successfully treated acute bipolar mood episode

30

If the drug that managed the acute mood episode in bipolar doesn't work how is patient managed?

2nd line: lithium/valproate/Lamotrigine