Bipolar Disorder Medications Flashcards Preview

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Flashcards in Bipolar Disorder Medications Deck (37):
1

What are bipolar I and bipolar II disorder characterized by?

Bipolar I-- Acute mania

Bipolar II -- Acute hypomania

Both -- Bipolar depression or Bipolar maintenance

2

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

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

3

What is the firstline treatment for bipolar disorder?

Lithium

4

List some of the beneficial effects of Lithium for bipolar patients

Effective for both acute mania and bipolar depression

Reduces risk of suicide in people with bipolar I

Good maintenance treatment, preventing mania and depression

5

Lithium MOA and Effects on NTs

MOA unclear

Increases effects of 5-HT

Decreases turnover of NE and DA

Increase Ach synthesis

6

Lithium
Absorption and Blood-Protein Binding

Well absorbed orally

Does NOT bind blood proteins

7

Lithium
Excretion

100% renal excretion

8

Lithium
Interaction with Carbonic anhydrase inhibitor diuretics

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.

9

Lithium
Interaction with Osmotic Diuretics

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.

10

Lithium
Interaction with Loop Diuretics

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

May increase or decrease Li+ excretion. Effects are debated

11

Lithium
Interaction with Thiazide Diuretics

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

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

12

Lithium
Interaction with K+ Sparing Diuretics

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

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

13

Lithium
Interaction with ACE inhibitors and ATII receptor antagonists

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

Overall increase in lithium blood levels

14

How does hyponatremia effect lithium levels?

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

15

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

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.

16

How does renal impairment affect lithium levels?

Increase blood lithium levels

17

List some common side effects of lithium

Hypothyroidism
Nausea
Diarrhea
Fine tremor
Decreased concentration
Sedation
Weight gain

18

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

Nephrogenic diabetes insipdus (10 or more years)

19

Symptoms of Lithium Toxicity

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

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

TSH

Renal function

ECG if pt is over 50yo

Weight

Pregnancy

21

Valproic acid is AKA...

Divalproex Sodium (Depakote)

22

Depakote
Absorption and Protein Binding

100% oral absorption

Highly protein bound, which may cause drug-drug interactions

23

Depakote
Metabolism

Hepatic metabolism

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

24

Depakote
Side Effects

Nausea/Vomiting
Diarrhea
Tremor
Sedation
Weight Gain

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

25

Hepatic Side Effects of Depakote

Mild increase in LFTs

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

Hyperammonemia

26

Depakote
What tests should you check before starting?

LFTs
Platelets
Weight
Pregnancy test

27

Carbamazepine
Protein binding

Moderate protein binding (70-80%)

28

Carbamazepine
Metabolism

Hepatic

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

29

Carbamazepine
Side Effects

Nausea, vomiting

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

30

Lamotrigine
Protein binding

Low protein binding

31

Lamotrigine
Metabolism

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

32

Lamotrigine
Side Effects

Nausea, vomiting

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

33

2nd Gen AntiPsychotics
Indication

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

Which bipolar med has the highest risk of birth defects?

Depakote

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

35

Which bipolar med has the lowest risk of birth defects?

Lamotrigine

36

Lamotrigine
Indications

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

37

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

Benzodiazepines

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