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Flashcards in Bipolar Disorder Treatment Deck (43)
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1
Q

Bipolar Type I

A

1+ manic/mixed episodes AND major depressive episode

2
Q

bipolar type II

A

1+ major depressive episode and at least 1 hypomanic episode

often misdiagnosed

3
Q

mixed bipolar disorder

A

presence of manic and depressive episodes at same time

4
Q

considerations of bipolar disorders

A

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

5
Q

top consideration for bipolar disorder

A

medications causing mania

L-Dopa, corticosteroids

6
Q

etiology of bipolar disorder

A

unknown

can have genetic, neurobiology, psychologic theories

7
Q

treatment goals of bipolar

A

resolved acute manic, hypomanic, and depressive episodes

maintain ADL functioning

promote adherence

decreased S.E.

8
Q

non-pharm treatment

A

adequate nutrition

exervise

stress reduction

sleep

counseling

9
Q

treatment considerations: mixed episode

A

valproate preferred

10
Q

treatment considerations

bipolar depression (preferred)

A

lithium/lamotrigine preferred over valproate

11
Q

treatment considerations

euphoric mania

A

lithium DOC

12
Q

treatment consideration

bipolar depression only mono therapies approved

A

quetiapine
lurasidone

(SGAs)

13
Q

gold standard for type I bipolar depression

A

lithium

14
Q

lithium mechanism

A

unknown but it is neuroprotective

15
Q

anti manic effects of lithium timeline

A

1-2 weeks

use bentos, SGAs to cover

16
Q

anti depressive effects of lithium timeline

A

6-8 weeks

17
Q

normal values for lithium

A

0.6-1.2 mEq/L

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

18
Q

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

A

** hypothyroidism, teratogenicity ***

tremor, CNS toxicity, GI, polydipsia, polyuria

19
Q

what interactions DECREASE concentration of lithium

A

theophylline

pregnancy (increase GFR)

20
Q

what must you monitor closely if using lithium

A

TSH

can cause hypothyroidism

21
Q

what drugs INCREASE concentration of lithium

A
  1. ACE/ARBs
  2. NSAIDs
  3. Thiazide- hydrochlorothiazide
22
Q

pre lithium initiation monitoring

A
  1. CBC
  2. BMP
  3. TSH
  4. urinalysis
  5. pregnancy test
23
Q

continual lithium monitoring

A

serum Li levels
renal function
thyroid

24
Q

anticonvulsants drug list

A
  1. Divalproex or Valproic Acid/Depacon, Depakote ER
  2. Carbamazepine (Tegretol/Equetro)
  3. Lamotrigine/Lamictal
25
Q

divalproex

A

valproic acid

depacon
depakote

26
Q

carbamazepine

A

equator

tegretol

27
Q

lamotrigine

A

lamictal

28
Q

divalproex

mechanism

A

increases availability of GABA at post synaptic site

29
Q

divalproex

bipolar uses

A

not as effective in depressive episodes

acute and maintenance treatment

30
Q

Side effects of divalproex

A

common: weight gain, hair loss, tremor

hepatotoxity

teratogenicity

rare: thrombocytopenia, pancreatitis

31
Q

drug interactions divalproex

A

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

32
Q

carbamazepine use in bipolar disorder

A

acute and maintenance

33
Q

carbamazepine side effects

A

common: fatigue, n/v

**rash (HLA -B*1502 with asians)
SIADH
rare risk of agranulocytosis

34
Q

carbamazepine metabolism

A

CYP3A4 AUTOinducer

35
Q

oxcarbazepine (trileptal)

A

related to carbamazepine

less hyponatremia, pancytopenia

no auto induction

36
Q

Lamotrigine mechanism

A

inhibits glutamate transmission

37
Q

lamotrigine use in bipolar

A

DEPRESSED phase of bipolar

[less effective in mainic)

38
Q

Lamotrigine S.e.

A

common: HA, n, ifxn, dry mouth

SJS rash

39
Q

lamotrigine

use with valproic acid

A

decrease dose 50%

40
Q

lamotrigine

use with carbamazepine

A

increase dose by 50%

41
Q

antipsychotics in bipolar depression (which drug)

A

quetiapine

lurasidone

42
Q

antipsychotics in maintenance of bipolar

A

Risperdal consta

Ability maintena

43
Q

antidepressants in bipolar

A

never first line

controversial because it can induce manic phase

never use if manic symptoms present or mono therapy