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Psych Final > Bipolar Therapeutics - Mania > Flashcards

Bipolar Therapeutics - Mania Flashcards

(69 cards)

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1
Q

_____ is required to diagnose bipolar disorder

A

mania

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2
Q

“cyclic mood disorder”

A

bipolar

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3
Q

often, ____ episodes happen before _____ episodes in bipolar disorder

A

depressive happen before manic

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4
Q

true or false

to be classified as mania, the patient must have psychotic features

A

FALSE - can be with or without

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5
Q

briefly state some mania symptoms

A

lot of ideas
inflated self esteem
decreased need for sleep
talkative
very distracted

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6
Q

differentiate between bipolar 1 disorder and bipolar 2

A

bipolar 1 - at least 1 manic episode, episode of MDD or hypomania is NOT NEEDED for diagnosis. many present with psychotic features

bipolar II - at least 1 hypomanic episode. at least 1 major depressive episode needed

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7
Q

true or false

in bipolar II disorder, there has NEVER been a manic episode

A

true

only hypomanic

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8
Q

name some classes of drugs that can INDUCE MANIA

A

antidepressants (all)
stimulants/sympathomimetics
dopamine agonists
carbidopa-levodopa

steroids, androgens, thyroid supplements

drugs of abuse

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9
Q

name some classes of drugs that can induce DEPRESSION

A

antihypertensives (beta blockers, clonidine)

CNS depressants

hormonal agents - anabolic steroids, corticosteroids, progestin/estrogen, tamoxifen, drugs of abuse

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10
Q

true or false

it’s possible for corticosteroids to induce mania and depression

A

true

also drugs of abuse

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11
Q

what are the “treatment phases” in bipolar disorder

A

acute and maintenance

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12
Q

what classes of meds are considered 1st line for manic symptoms

A

mood stabilizers and antipsychotics

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13
Q

first line for depressive phase of bipolar

A

taken case by case
antidepressants, benzos

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14
Q

what is the most extensively studied agent for bipolar disorder and is considered the gold standard

A

lithium

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15
Q

2 FDA indications for lithium

A

-acute mania
-maintenance for bipolar

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16
Q

ONLY bipolar agent that has shown decrease suicidality

A

lithium

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17
Q

most common AE of lithium.
how can they be avoided?

A

GI adverse events

titrate the dose of lithium! the GI adverse effects are dose dependent

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18
Q

lithium contraindications

A

-significant renal or cardiac disease

-sodium depletion/extreme dehydration

-concurrently using a diuretic

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19
Q

what creatinine clearance can lithium not be used

A

under 30

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20
Q

acronym to remember the AE of lithium

A

ABCDEFGHI N (nephrotoxicity)

A- acne, alopecia
B - benign leukocytosis
C - cardiac rhythm changes (not urgent)
D - diabetes insipidus + dizzy
E - excessive thirst, urination, ebstein’s anomaly
F - fine motor tremor
G - GI upset
H - hypothyroidism
I - impaired cognition

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21
Q

true or false

an AE of lithium is hyperthyroidism

A

FALSE- hypothyroidism

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22
Q

diuretics, NSAIDS, ACEI’s, ARBS, dehydration, and sodium restriction all will cause ________ when given with lithium

A

INCREASED LITHIUM CONCENTRATIONS

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23
Q

true or false

sodium supplements + lithium causes increase lithium concentrations

A

FALSE - decreased

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24
Q

true or false

sodium polystyrene sulfonate + lithium causes decreased lithium concentrations

A

true

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25
******important blood ranges for lithium
for acute mania: 0.6-1.2mEq/L for maintenance mania: 0.6-1mEq/L
26
lithium levels should be checked ____ days after initiation or a dose change. the blood should be drawn _____ after the last dose
5 days after initiation or dose change 12 hours after the last dose
27
once STABILIZED on lithium, how often should blood levels be checked
every 1-3 months
28
true or false if a pt has symptoms of lithium toxicity, we should check the blood levels immediately
true
29
if a patient has been on lithium and we just added some potential interacting medications, how often should the lithium levels be checked
1-2x a week draw the blood 12 hours after the last lithium dose
30
some labs to check for a patient on lithium
lithium levels renal function BMP (electrolytes) thyroid function CBC with differential dermatologic exam tremors OTC NSAIDS periodic EKG
31
2 FDA indications for valproic acid
for acute mania and for maintenance of bipolar disorder (same as lithium)
32
true or false for all formulations of valproic acid, it is a 1:1 conversion
FALSE all EXCEPT ER-DR 1.2:1
33
true or false when converting from ER to DR valproic acid, we have to increase the dose by 20%
FALSE decrease the dose by 20%
34
valproic acid is CI in severe ____ impairment
hepatic
35
true or false valproic acid needs no dose adjustment in renal failure
true
36
4 BBW of valproic acid
pancreatitis hepatotoxicty teratogen mitochondrial disease
37
acronym for AE of valproic acid
VALPROATE V - vomiting, nausea A - alopecia L - liver toxicity P - pancreatitis, PCOS, low platelets R - Rash O - obesity A - hypperammonia T - teratogen, tremors, thrombocytopenia E - exhaustion (sedation), encephalopathy
38
which dosage form of valproic acid is associated with the most GI upset and nausea
immediate release/liquid
39
we should consider lowering the valproic acid dose if the levels are consistently at or above _________
100mg/L
40
name 3 things that INDUCE the metabolism of valproic acid
carbamazepine phenytoin phenobarbital/primidone
41
topiramate + valproic acid
increased risk of hyperammonemia and encephalopathy
42
**important ranges for valproic acid
acute mania - 50-125mg/L maintenance - 50-100mg/L toxicity - over 125mg/L
43
toxicity lithium levels
1.5-2mEq/L SEVERE toxicity - over 2.5mEq/L
44
valproic acid levels should be checked ____ days after initiation or dose change how long should they be drawn after the last dose?
3 should be drawn 12 hours after last dose for DR tablets or 24 hours after last dose for ER tablets
45
once stabilized, how often should valproic acid levels be checked
every 3-6 months
46
lab monitoring for valproic acid
drug levels LFTs (hepatotoxicity!) ammonia (if altered mental status) CBC iwth differential amylase/lipase (if pancreatitis is suspected)
47
true or false carbamazepine is considered 1st line for bipolar disorder
FALSE not considered 1st line bc many DDI, tolerability issues, and an unpredictable PK profile compared to lithium and valproic acid
48
true or false carbamazepine is a CYP inhibitor
FALSE - inducer
49
true or false carbamazepine dose should be reduced for hepatic failure but not renal
true
50
**carbamazepine levels
maintenance and acute mania 4-12mcg/L toxicity over 15
51
important consideration before starting someone on carbamazepine
watch for HLA-B*1502 allele!!!! toxic epidermal necrolysis all patients with asian ancestry should be screened
52
BBWs of carbamazepine
dermatologic reactions! SJS, TEN in HLB-B*1502 allele aplastic anemia, agranulocytosis
53
carbamazepine is contraindicated with what psychiatric drugs
those induced by 3A4 ie - lurasidone, nefazodone, valbenazine, clozapine
54
carbamazepine can enhance the _____ effects of clozapine
myelosuppressive
55
aside from psych drugs induced by 3A4, name another class of drugs that is contraindicated with carbamazepine
antiretrovirals
56
carbamazepine + contraceptives
use other birth control
57
specific electrolyte to monitor in carbamazepine
sodium
58
"very true levels" meaning
valproic acid - 3 days to steady state tegretol (carbamazepin) - 4 days to steady state lithium - 5 days to steady state
59
structural derivative of carbamazepine what is it used for?
oxcarbazepine used OFF LABEL for bipolar mania. it is NOT effective for bipolar depression
60
true or false oxcarbazepine is used off label for bipolar depression. it is NOT effective for bipolar mania
FALSE - other way around used off label for bipolar mania, not effective for bipolar depression
61
true or false oxcarbazepine is NOT considered 1st line
true
62
how is oxcarbazepine an advantage over carbamazepine
no BBW, no monitoring levels, improved AE profile (less rashes and hyponatremia), reduced DDI, doesn't autoinduce itself (no weird PK profile)
63
true or false the typical antipsychotics are 1st line in bipolar disorder
FALSE - the atypicals 1st gen aren't 1st line bc of EPS risk
64
true or false when the atypicals are used for bipolar, they can ONLY be used as monotherapy
false - can be mono or dual (with a mood stabilizer)
65
7 specific atypicals that are approved for treatment and maintenance of bipolar mania
aripiprazole asenapine cariprazine olanzapine quetiapine risperidone ziprasidone (paliperidone is effective but doesn't have FDA approval)
66
if a bipolar patient is pregnant, what drugs are preferred to treat the mania
the atypicals are preferred over carbamazepine or valproic acid
67
true or false all antipsychotics are considered effective for bipolar depression
FALSE
68
recap - 3 general drugs used for bipolar mania
lithium anticonvulsants (CBZ/VPA) atypicals
69

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