Bipolar Disorder Pharmacotherapy Flashcards
(41 cards)
Medical Conditions that Cause Mania
Addison’s/Cushings Disease AIDS Epilepsy Head injuries Hyperthyroidism Neurosyphilis Post-stroke
Substance Disorders that Cause Mania
Alcohol
Anabolic steroids
Hallucinogens: LSD, PCP
Methamphetamine and cocaine
Medications that Cause Mania
ADHD Stimulants Antidepressants Benzodiazepine withdrawal Beta 2 agonists Caffeine and theophylline Clonidine withdrawal Corticosteroids Parkinson’s medications Sympathomimetics Thyroid Supplements
Mania DSM-5 Criteria
Greater than 1 week of abnormal increased mood (expressive or irritable) associated with 3 of the following (4 if mood is only irritable): o Decreased need for sleep o Increased activity or agitation o Increased self-esteem (grandiosity) o Increased talking or pressured speech o Poor attention o Racing thoughts o Excessive involvement in activities that are pleasurable but have a high risk for serious consequences
Hypomania DSM 5 Criteria
DSM-5 criteria same as manic but symptoms are less severe.
The symptoms do not impair daily function nor does the patient have to be hospitalized.
Define Bipolar 1
diagnosed if the patient has had a full manic episode in their lifetime.
- Impairs daily living
Define Bipolar 2
diagnosed if the patient has had both hypomanic and depressive episodes in their lifetime
Define Rapid Cycling
greater than or equal to 4 depressive or manic episodes in 12 months
Define Mixed features
Switches back and forth nearly every day for at least 1 week
- Symptoms do impair daily function or pt has to be hospitalized
Electroconvulsive Therapy
Mania and depressed
Treatment resistant, suicidal, pregnant
Electrical charge is applied to stimulate the brain and produce a seizure that last ~ 1 minutes. Treatment course: 6-12 treatments
***Acute Manic Episode Treatment
Mood stabilizers (lithium and valproic acid) and 2nd generation antipsychotics - Benzodiazipine can be used to induce sleep or treat agitiation
***Acute Depressive Episode Treatment
Lithium, lamotrigine and quetiapine
Antidepressants can be used as adjunct only
Acute Manic Episode First-line Drugs
Lithium or divalproex (valproate)
Olanzapine, quentiapine, asenapine
Risperidone, ziprasidone, paliperidone
Aripiprazole
Acute Depressive Episode First-line Drugs
Lithium or lamotrigine
Quetiapine
Acute Manic Episode First-line Combination Drugs
Lithium or divalproex + risperidone, quetiapine, olanzapine, asenapine, or aripiprazole
Acute Depressive Episode First-line Combination Drugs
Lithium or divalproex + SSRI (fluoxetine, zoloft)
Olanzapine + SSRI
Lithium + Divalproex
Lithium or divalproex + bupropion
Lithium Predisposing factors to toxicity
Decreased sodium levels
Dehydration
V/D
Lithium Mild Toxicity
1.2-1.5
memory difficulty and tremor
Lithium Moderate Toxicity
1.5-3.0
Confusion, ataxia, emesis, tremors
Lithium Severe Toxicity
Greater than 3.0
Seizures, brain damage, coma, death
Lithium Acute Monitoring Level
0.8-1.5
Acute has increased excretion of lithium
Lithium Maintenance Monitoring Level
0.6-1.2
Lithium Level monitoring
Always obtain a steady state concentration at 5 days → when desired blood levels have been achieved, obtain levels every 1-2 weeks for 2 months → once patient is maintained on a dose, obtain levels approximately every 6 months.
Lithium Measure after 5 days for steady state when:
Dosage change
Add or d/c drugs that interacts
Renal changes
Predisposing factory for toxicity
