Bipolar Disorder Treatment

Question 1

Bipolar Type I

Answer 1

1+ manic/mixed episodes AND major depressive episode

Question 2

bipolar type II

Answer 2

1+ major depressive episode and at least 1 hypomanic episode

often misdiagnosed

Question 3

mixed bipolar disorder

Answer 3

presence of manic and depressive episodes at same time

Question 4

considerations of bipolar disorders

Answer 4

women - hormone variations (leutal phase)
alcohol/substance abuse - self medication
suicidality
medications causing mania

Question 5

top consideration for bipolar disorder

Answer 5

medications causing mania

L-Dopa, corticosteroids

Question 6

etiology of bipolar disorder

Answer 6

unknown

can have genetic, neurobiology, psychologic theories

Question 7

treatment goals of bipolar

Answer 7

resolved acute manic, hypomanic, and depressive episodes

maintain ADL functioning

promote adherence

decreased S.E.

Question 8

non-pharm treatment

Answer 8

adequate nutrition

exervise

stress reduction

sleep

counseling

Question 9

treatment considerations: mixed episode

Answer 9

valproate preferred

Question 10

treatment considerations

bipolar depression (preferred)

Answer 10

lithium/lamotrigine preferred over valproate

Question 11

treatment considerations

euphoric mania

Answer 11

lithium DOC

Question 12

treatment consideration

bipolar depression only mono therapies approved

Answer 12

quetiapine
lurasidone

(SGAs)

Question 13

gold standard for type I bipolar depression

Answer 13

lithium

Question 14

lithium mechanism

Answer 14

unknown but it is neuroprotective

Question 15

anti manic effects of lithium timeline

Answer 15

1-2 weeks

use bentos, SGAs to cover

Question 16

anti depressive effects of lithium timeline

Answer 16

6-8 weeks

Question 17

normal values for lithium

Answer 17

0.6-1.2 mEq/L

above this is toxic (more than 2 mEq/L)

Question 18

lithium side effects (L-I-T-H-I-U-M)

Answer 18

** hypothyroidism, teratogenicity ***

tremor, CNS toxicity, GI, polydipsia, polyuria

Question 19

what interactions DECREASE concentration of lithium

Answer 19

theophylline

pregnancy (increase GFR)

Question 20

what must you monitor closely if using lithium

Answer 20

TSH

can cause hypothyroidism

Question 21

what drugs INCREASE concentration of lithium

Answer 21

1. ACE/ARBs
2. NSAIDs
3. Thiazide- hydrochlorothiazide

Question 22

pre lithium initiation monitoring

Answer 22

1. CBC
2. BMP
3. TSH
4. urinalysis
5. pregnancy test

Question 23

continual lithium monitoring

Answer 23

serum Li levels
renal function
thyroid

Question 24

anticonvulsants drug list

Answer 24

1. Divalproex or Valproic Acid/Depacon, Depakote ER
2. Carbamazepine (Tegretol/Equetro)
3. Lamotrigine/Lamictal

Question 25

divalproex

Answer 25

valproic acid depacon depakote

Question 26

carbamazepine

Answer 26

equator | tegretol

Question 27

lamotrigine

Answer 27

lamictal

Question 28

divalproex mechanism

Answer 28

increases availability of GABA at post synaptic site

Question 29

divalproex bipolar uses

Answer 29

not as effective in depressive episodes acute and maintenance treatment

Question 30

Side effects of divalproex

Answer 30

common: weight gain, hair loss, tremor hepatotoxity teratogenicity rare: thrombocytopenia, pancreatitis

Question 31

drug interactions divalproex

Answer 31

valproic acid increases lamotrigine concentrations so you have to decrease amount of lamotrigine giving by 50%

Question 32

carbamazepine use in bipolar disorder

Answer 32

acute and maintenance

Question 33

carbamazepine side effects

Answer 33

common: fatigue, n/v **rash (HLA -B*1502 with asians) SIADH rare risk of agranulocytosis

Question 34

carbamazepine metabolism

Answer 34

CYP3A4 AUTOinducer

Question 35

oxcarbazepine (trileptal)

Answer 35

related to carbamazepine less hyponatremia, pancytopenia no auto induction

Question 36

Lamotrigine mechanism

Answer 36

inhibits glutamate transmission

Question 37

lamotrigine use in bipolar

Answer 37

DEPRESSED phase of bipolar [less effective in mainic)

Question 38

Lamotrigine S.e.

Answer 38

common: HA, n, ifxn, dry mouth SJS rash

Question 39

lamotrigine use with valproic acid

Answer 39

decrease dose 50%

Question 40

lamotrigine use with carbamazepine

Answer 40

increase dose by 50%

Question 41

antipsychotics in bipolar depression (which drug)

Answer 41

quetiapine lurasidone

Question 42

antipsychotics in maintenance of bipolar

Answer 42

Risperdal consta Ability maintena

Question 43

antidepressants in bipolar

Answer 43

never first line controversial because it can induce manic phase never use if manic symptoms present or mono therapy