Bipolar Pharm

Question 1

What medications can trigger mania?

Answer 1

SSRIs

SNRIs

Question 2

What are the 2 factors that shape treatment of bipolar disorder?

Answer 2

How the patient has been affected by disorder

How the patient will be helped by treatment

Question 3

What should patients be assessed for when presenting with mania?

Answer 3

Suicide risk
Aggressiveness
Risk of violence to others
Ability to adhere to treatment program
Substance abuse evaluation & treatment
Alcohol, caffeine, & nicotine intake

Question 4

What should be discontinued when a patient presents with mania?

Answer 4

Antidepressants

Question 5

Classes of Medications

Answer 5

Mood Stabilizers: lithium, anticonvulsants
First generation antipsychotics
Second generation antipsychotics

Question 6

Mood Stabilizing Agents

Answer 6

Lithium
Valproate (Depakote)
Carbamazepine (Tegretol)

Question 7

What is important in determining which mood stabilizer to use?

Answer 7

Previous history
SE profile
Co-existing medical illness

Question 8

Mood Stabilizing Agent SE

Answer 8

Drowsiness
Dizziness
Headache
Diarrhea
Constipation
Heartburn
Mood swings
Stuffed/runny nose
Other cold-like symptoms

Question 9

Lithium

Answer 9

Decreases frequency & severity of manic & depressive episodes
Decrease norepi and dopamine turnover
Blocks dopamine receptor supersensitivity
Augment synthesis of acetylcholine
May work better in maintenance phase

Question 10

Why Lithium?

Answer 10

Low therapeutic index
Constant blood level monitoring
Renal clearance reduced by diuretics
Tremor common SE
Decreased thyroid function
Polydipsia, polyuria
Edema, weight gain

Question 11

Labs to Monitor Lithium

Answer 11

BUN
Creatinine
Thyroid function tests
Lithium levels

Question 12

Why Valproate (Depakote)

Answer 12

SE profile less than lithium
Quick onset
Increase dose more rapidly
Larger therapeutic window

Question 13

What drug class is valproate (Depakote) in?

Answer 13

Anti-convulsant

Question 14

SE of Valproate (Depakote)

Answer 14

Weight gain
N/V
Hair loss
Tremor

Question 15

Labs for Monitoring Valproate (Depakote)

Answer 15

Liver functions
Platelets
Valproate levels

Question 16

What drug class is carbamazepine (Tegretol) in?

Answer 16

Anti-convulsant

Question 17

SE of Carbamazepine (Tegretol)

Answer 17

N/V
Hyponatremia
Rash (SJS & TENS)
Drowsiness
Blurred vision
Blood dyscrasia's

Question 18

Labs to Monitor with Carbamazepine (Tegretol)

Answer 18

Liver function tests
CBC
Serum sodium
Carbamazepine levels

Question 19

What drug class is lamotrigine (Lamictal)

Answer 19

Anti-convulsant

Question 20

What does lamotrigine (Lamictal) treat?

Answer 20

Bipolar depression without triggering mania, hypomania, mixed states, or rapid cycling

Question 21

What medication is not recommended for treatment of acute mania

Answer 21

Lamotrigine

Question 22

Medications to use in acute severe manic or mixed episodes

Answer 22

Anti-psychotic +

Lithium or Valproate

Question 23

Medications to use in acute moderate manic or mixed episode

Answer 23

Lithium OR
Valproate OR
Antipsychotic agent

Question 24

Examples of First Generation Antipsychotics

Answer 24

Haloperidol (Haldol)

Chlorpromazine (Thorazine)

Question 25

Shortcomings of FGAs

Answer 25

Small percentage of patients helped to recover | Annoying & serious AE

Question 26

AE of FGAs

Answer 26

Akathisia Parkinsonian-like rigidity & tremor Tardive dyskinesia Neuroleptic malignant syndrome

Question 27

Define Akathisia

Answer 27

Subjective feeling of muscular tension which can cause restlessness, pacing, repeated sitting or standing

Question 28

SE of FGA Dopamine Antagonists

Answer 28

Extrapyramidal symptoms: dyskinesia, tardive dyskinesia Akathisia Dystonia

Question 29

Define Dyskinesia

Answer 29

Movement disorders including any of a number of repetitive, involuntary, & purposeless body or facial movements

Question 30

Examples of Dyskinesia

Answer 30

``` Tongue movements Lip smacking Finger movements Eye blinking Movements of the arms or legs ```

Question 31

When does tradeoff dyskinesia occur?

Answer 31

After long-term treatment with an antipsychotic medication

Question 32

Define Akathisia

Answer 32

Extreme form of internal or external restlessness

Question 33

Define Dystonia

Answer 33

Muscle tension disorder involving very strong muscle contractions

Question 34

MOA of Cogentin

Answer 34

Blocks the effects of the neurotransmitter acetylcholine

Question 35

What drug class is effective in treating the negative symptoms of Bipolar Disorder?

Answer 35

SGAs

Question 36

SE of SGAs

Answer 36

``` Weight gain Glucose intolerance DM Hyperlipidemia Drowsiness Dizziness with changing positions Blurred vision Rapid HR Sensitivity to the sun Skin rashes Menstrual problems ```

Question 37

Labs & Other Items to Watch with SGAs

Answer 37

Serum glucose Lipids Weight Waist circumference

Question 38

Examples of SGAs

Answer 38

``` Quetiapine (Seroquel) Olanzapine (Zyprexa) Risperidone (Risperdal) Clozapine (Clozaril) Ziprasidone (Geodon) Aripiprazole (Abilify) ```

Question 39

Most Severe SE in Quetiapine (Seroquel)

Answer 39

Drowsiness

Question 40

Most Severe SE in Olanzapine (Zyprexa)

Answer 40

Weight gain

Question 41

2 Most Severe SE in Clozapine (Clozaril)

Answer 41

Weight gain | Agranulocytosis

Question 42

1st line therapy for acute depression in patients with bipolar disorder

Answer 42

Lithium OR | Lamotrigin (Lamictal)

Question 43

When is hospitalization indicated in bipolar patients?

Answer 43

Diagnostic purposes Stabilization of medications Patient's safety Grossly disorganized or inappropriate behavior