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Pharmacology > Bipolar Disorder Medications > Flashcards

Bipolar Disorder Medications Flashcards

1
Q

What are bipolar I and bipolar II disorder characterized by?

A

Bipolar I– Acute mania

Bipolar II – Acute hypomania

Both – Bipolar depression or Bipolar maintenance

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2
Q

Why should bipolar disorder never be treated with an anti-depressant alone?

A

You could flip them into a manic episode! Always be sure the person takes a mood stabilizer along with the antidepressant for bipolar disorder

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3
Q

What is the firstline treatment for bipolar disorder?

A

Lithium

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4
Q

List some of the beneficial effects of Lithium for bipolar patients

A

Effective for both acute mania and bipolar depression

Reduces risk of suicide in people with bipolar I

Good maintenance treatment, preventing mania and depression

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5
Q

Lithium MOA and Effects on NTs

A

MOA unclear

Increases effects of 5-HT

Decreases turnover of NE and DA

Increase Ach synthesis

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6
Q

Lithium

Absorption and Blood-Protein Binding

A

Well absorbed orally

Does NOT bind blood proteins

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7
Q

Lithium

Excretion

A

100% renal excretion

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8
Q

Lithium

Interaction with Carbonic anhydrase inhibitor diuretics

A

Those diuretics work in the PCT. They are acetazolamide, methazolamide, and dichlorphenamide.

They result in an increase in lithium excretion, thus decreasing Li+ blood levels.

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9
Q

Lithium

Interaction with Osmotic Diuretics

A

These diuretics work in the PCT. Act by increasing tubular fluid osmolality. Mannitol.

They result in an increase in lithium excretion, thus decreasing Li+ blood levels.

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10
Q

Lithium

Interaction with Loop Diuretics

A

Block the NKCC2 channel in the thick ascending loop. Furosemide.

May increase or decrease Li+ excretion. Effects are debated

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11
Q

Lithium

Interaction with Thiazide Diuretics

A

Block the Na+/Cl- transporter in the DCT. Hydrochlorothiazide.

Decrease lithium excretion, leading to an increase in blood levels of Lithium

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12
Q

Lithium

Interaction with K+ Sparing Diuretics

A

Act at the collecting duct to antagonize aldosterone receptors. Spironolactone and amiloride.

Decrease lithium excretion, thus resulting in higher lithium blood levels.

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13
Q

Lithium

Interaction with ACE inhibitors and ATII receptor antagonists

A

Inhibit ATII production, leading to less aldosterone, thus more Na+/Li+ reabsorption at collecting duct

Overall increase in lithium blood levels

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14
Q

How does hyponatremia effect lithium levels?

A

Body will try to hang onto more Na+ (and thus Li+), so blood lithium levels will increase

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15
Q

How does pregnancy affect lithium levels? How will this affect your dosing of lithium throughout and after labor?

A

Decrease lithium levels (higher excretion).

During pregnancy, give lithium at a higher dose. Hold the lithium during labor, then give her lithium at HALF dose after delivery.

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16
Q

How does renal impairment affect lithium levels?

A

Increase blood lithium levels

17
Q

List some common side effects of lithium

A 
Hypothyroidism
Nausea
Diarrhea
Fine tremor
Decreased concentration
Sedation
Weight gain
18
Q

What is a serious side effect of lithium, seen after years of taking lithium?

A

Nephrogenic diabetes insipdus (10 or more years)

19
Q

Symptoms of Lithium Toxicity

A

Mild – Nausea, Vomiting, Diarrhea, Lethargy, Drowsiness, Muscle weakness, coarse hand tremor

Moderate– Confusion, Myoclonic twitch, dysarthria, ataxia, ECG changes

Severe- impaired consciousness, coma, seizures, syncope

20
Q

Before starting a patient on lithium, what tests should you check?

A

TSH

Renal function

ECG if pt is over 50yo

Weight

Pregnancy

21
Q

Valproic acid is AKA…

A

Divalproex Sodium (Depakote)

22
Q

Depakote

Absorption and Protein Binding

A

100% oral absorption

Highly protein bound, which may cause drug-drug interactions

23
Q

Depakote

Metabolism

A

Hepatic metabolism

Inhibits the glucoronidase system, which may affect the hepatic metabolism of other drugs like carbamazepine

24
Q

Depakote

Side Effects

A 
Nausea/Vomiting
Diarrhea
Tremor
Sedation
Weight Gain

Less common: ataxia, headaches, dizziness, thrombocytopenia, hyperammonemia, hepatotoxicity

25
Q

Hepatic Side Effects of Depakote

A

Mild increase in LFTs

Hepatotoxicity (may be fatal in children under 2 who are on many antiseizure meds)

Hyperammonemia

26
Q

Depakote

What tests should you check before starting?

A

LFTs
Platelets
Weight
Pregnancy test

27
Q

Carbamazepine

Protein binding

A

Moderate protein binding (70-80%)

28
Q

Carbamazepine

Metabolism

A

Hepatic

Induces its own metabolism by P450 system (may also induce metabolism of other drugs)

29
Q

Carbamazepine

Side Effects

A

Nausea, vomiting

Neuro side effects are caused by a metabolite of Carbamazepine (dizziness, sedation, ataxia, diplopia)

30
Q

Lamotrigine

Protein binding

A

Low protein binding

31
Q

Lamotrigine

Metabolism

A

Primarily hepatic by glucoronidation. Lamotrigine metabolism may be induced by carbamazepine, or inhibited by depakote

32
Q

Lamotrigine

Side Effects

A

Nausea, vomiting

Rash –> could be benign or Steven Johnsons Syndrome, so you need to treat it

33
Q

2nd Gen AntiPsychotics

Indication

A

Used in treating severe bipolar mania (only when the patient is psychotic or exhibits suicidal/dangerous behavior)

Used in combination with either lithium or depakote for severe bipolar mania

34
Q

Which bipolar med has the highest risk of birth defects?

A

Depakote

Risk of neural tube defects is 3-5% with depakote

35
Q

Which bipolar med has the lowest risk of birth defects?

A

Lamotrigine

36
Q

Lamotrigine

Indications

A

Used to prevent acute manic episodes (in maintenance treatment), but is NOT used to treat acute mania or hypomania

37
Q

What drug class may be used as an adjunct for acute mania or hypomania treatments (never used on its own for mania)?

A

Benzodiazepines

Pharmacology (67 decks)

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