Bipolar Therapeutics - Depression + considerations Flashcards
(28 cards)
3 general drugs used for bipolar depression
lithium
atypicals
lamotrigine
(not anticonvulsants - VPA/CBZ - like mania!)
differentiate between treating BIPOLAR depression vs regular depression
symptoms are identical
however, for BIPOLAR depression, antidepressants are NOT effective as monotherapy and for regular depression they are
also, in bipolar depression, certain antipsychotics may be effective as monotherapy, but in regular depression, antipsychotics only have an adjunct role and are not effective as monotherapy
acronym to remember the meds that can be used for bipolar depression in both types I and II
SOL4V IT
seroquel
olanzapine/fluoxetine
lurasidone
lithium
lamotrigine
lumateperone
vraylar
vraylar generic
cariprazine
true or false
antidepressants can be 1st line treatment for bipolar depression
FALSE - AVOID AS FIRST LINR
can cause a switch to mania/hypomania
also not effective for bipolar depression as monotherapy - only effective as monotherapy for regular depression
if we DO choose to use antidepressents for bipolar depression, what do we have to do
have to use with a mood stabilizer or with an antipsychotic
one of the drugs in the SOL4V IT acronym was olanzapine/fluoxetine. however, this is not considered 1st line
why
AE profile and drug interaction potential with 2D6
true or false
lamotrigine is FDA indicated for bipolar maintenance and bipolar depression
true
is lamotrigine used acutely
NO
due to extended titration schedule
WHY does lamotrigine have a strict dosing schedule
less the risk of getting SJS and TEN
true or false
lamotrigine is not safe to use in pregnancy
false - it is
BBW lamotrigine
life threatening rashes (SJS, TEN)
increased risk in kids, when given with valproic acid, or exceeding dosage titration guidelines
true or false
if a patient gets a rash on lamotrigine, they MUST STOP IMMEDIATELY
true
when does a patient have to restart the lamotrigine titration
if they miss 5 days of therapy
2 things FDA approved for both mania AND bipolar depression
cariprazine (vraylar)
quetiapine
the biggest risks to the fetus are during what trimester of pregnancy
1st
true or false
antipsychotics are considered unsafe in pregnancy
FALSE- considered relatively safee
can use haloperidol or atypicals
the 1st gens have the largest body of safety evidence
____ and ___ should be AVOIDED in pregnancy
valproic acid and carbamazepine
can lithium be used in pregnancy
AVOID during 1st trimester
can use in 2nd or 3rd - risks are low
likely will need dose adjustments in pregnancy bc increased clearance
ebstein’s anomaly in fetus
lamotrigine can be used for maintenance and treatment of bipolar depression in pregnancy
however, what are some dose considerations
drug is cleared faster in pregnancy
target range is 1-6mcg/mL
may be smart to titrate the dose BEFORE pregnancy if possible
for the 1st ____ months of bipolar treatment, patients are at high risk of relapse
6 months
true or false
lamotrigine is used to treat bipolar depression and it is not effective for acute mania
true
true or false
it is very unlikely that bipolar patients need to be on bipolar medication forever
false - it is
most important lithium monitoring parameter (aside from drug levels)
serum creatinine
