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Psychopharmacology > Lecture 20: Drugs for Bipolar Disorder > Flashcards

Lecture 20: Drugs for Bipolar Disorder Flashcards

1
Q

diagnostic criteria for bipolar I (vs. II)

A
  1. at least one episode of mania
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2
Q

6 symptoms of mania

A
  1. irritability
  2. high risk activities
  3. inflated self esteem
  4. flight of ideas
  5. distractibility
  6. decreased need for sleep
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3
Q

5 differences between BD and MDD

A
  1. briefer duration
  2. more rapid onset
  3. anergia
  4. psychomotor retardation
  5. reversed vegetative symptoms (overeating and oversleeping)
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4
Q

BD prevalence

A

1%

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5
Q

age of onset

A

15-19

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6
Q

are males and females equally affected?

A

yes for BD1

no for BD2 (women > men)

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7
Q

mortality rate for BD

A

25-50% attempted suicide, 20% completed

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8
Q

compared to depression, BP has

A

higher heritability

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9
Q

BD may be ___% comorbid with another axis I disorder

A

100%

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10
Q

BD has significant reductions in volume of ___ (2)

A

PFC

hippocampus

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11
Q

BD has decrease in number of __ (2) in ___

A

neurons and glial cells

PFC

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12
Q

BD has reduced amount of ___

A

N-acetyl-aspartate

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13
Q

mood stabilizers may reverse impairments in ___

A

BDNF, brain structure

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14
Q

BDNF is part of the ___ family of growth factors

A

neurotrophin

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15
Q

neurotrophin

A

proteins induce survival, development, function, repair, and plasticity of neurns

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16
Q

rita levi-montalcini

A

1986 nobel prize for discovering nerve growth factor (causes developing cells to grow by stimulating surrounding nerve tissue)

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17
Q

lithium increases levels of (2)

A
  1. N-acetyl-aspartate

2. gray matter volume

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18
Q

lithium, valproate, and carbamazepine interact with __-

A

various enzymes involved in 2nd and 3rd messenger pathways

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19
Q

four classes of drugs

A
  1. lithium
  2. anticonvulsant mood stabilizers
  3. atypical antipsychotics (olanzapine)
  4. omega 3 fatty acids
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20
Q

6 anticonvulsant mood stabilizers

A
  1. carbamazepine
  2. valproic acid
  3. gabapentin
  4. lamotrigine
  5. topiramate
  6. oxcarbazepine
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21
Q

lithium efficacy

A

60-80% of acute episodes; 1/3 relapse

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22
Q

2 reasons lithium is used less often

A
  1. difficult to use safely

2. no patent -> low profits

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23
Q

metabolism of lithium

A

excreted unchanged by kidneys

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24
Q

3 (+1) clinical effects against mania for lithium

A
  1. decreases number, frequency, intensity of episodes

2. decreases subtle, transient mood swings between episodes

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25
Q

days for response of Li

A

5-10 days

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26
Q

what percent of people show good to excellent response to Li?

A

2/3

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27
Q

what percent of people show partial response to Li?

A

80%

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28
Q

what percent of Li treated patients have adverse reactions?

A

35-95%

29
Q

how is Li overdose treated?

A

dialysis

30
Q

Li has a ___ therapeutic range

A

narrow

31
Q

variations in __ intake affect Li retention

A

Na

32
Q

4 most common Li side effects

A
  1. hand tremor
  2. incoordination
  3. nystagmus
  4. muscle weakness
33
Q

choreoathetosis

A

big body movements that aren’t controllable (e.g. flinging your arms up)

34
Q

2 CNS complaints for Li

A
  1. complaints about creativityproductivity

2. lack/loss of excitement

35
Q

8 other side effects of Li

A
  1. antithyroid
  2. polyuria
  3. inhib vasopressin
  4. dipsogenic
  5. weight gain
  6. acne
  7. toxic arrhythmias in overdose
36
Q

pregnancy risk percent

A

4-12%

37
Q

what antiepileptic is no longer used?

A

carbamazepine (tegretol)

38
Q

teratogen

A

causes malformation in embryos

39
Q

comorbid substance abuse for BD I; BD II?

A

60%

50%

40
Q

guideline for manic/mixed episodes

A

lithium with antipsychotic, valproate with antipsychotic

41
Q

less ill patients are referred to

A

lithium, valproate, or antipsychotics like olanzapine

42
Q

patients with depressive episodes are commonly prescribed __

A

lithium, lamotrigine

43
Q

oxcarbazepine difference from carbamazepine

A

additional oxygen molecule

44
Q

2 benefits of oxcarbazepine over carbamazepine

A
  1. does not induce hepatic enzymes

2. fewer drug-drug interactions

45
Q

valproic acid MoA

A

binds to and inhibits GABA transaminase, increasing available GABA. may inhibit GABA reuptake; Na+ action potentials; gene transcription

46
Q

% valproic acid response rate in Li resistant patients

A

70%

47
Q

valproic acid is best in combination with ___

A

lithium, olanzapine

48
Q

MoA of carbamazepine

A

inactivates voltage-sensitive sodium channels (probably 2nd messengers)

49
Q

hyponatremia

A

electrolyte disturbance in which Na levels are too low

50
Q

leukopenia

A

decrease in number of WBCs

51
Q

6 side effects of carbamazepine

A
  1. sedation
  2. dry mouth
  3. blurred vision
  4. constipation
  5. blood disorders
  6. hyponatremia
52
Q

3 major problems with carbamazepine

A
  1. autoinduction of CYP450
  2. hepatic toxicity
  3. blood problems
53
Q

4 side effects of oxcarbazepine

A
  1. tiredness
  2. headache
  3. dizziness
  4. ataxia
54
Q

oxcarbazepine has been shown to be superior to placebo in the treatment of ___

A

acute mania

55
Q

carbamazepine should be replaced with ___

A

oxcarbazepine

56
Q

teratogenic effects of valproic acid

A

neural tube defects (spina bifida) in first trimester

57
Q

side effects of valproic acid (7)

A
  1. GI distress
  2. weight gain
  3. liver signs
  4. tremors
  5. sedation
  6. hair loss
  7. increased risk of PCOS; menstrual irregularities; hormonal problems
58
Q

lamotrigine half life

A

26 hours

59
Q

MoA lamictal

A

inhibits glutamate release

60
Q

about ___ of refractory patients respond to lamictal, vs __ for gabapentin or placebo

A

50%

25%

61
Q

about ___% of BD patients improve with topiramate

A

50%

62
Q

unique advantage of topiramate

A

weight loss

63
Q

topiramate has greater ___ than gabapentin or lamotrigine

A

cognitive dysfunction

64
Q

4 side effects of topamax

A
  1. tingling
  2. irritability
  3. anxiety
  4. depression
65
Q

use of topamax as an adjunct

A

improve efficacy and reduce weight gain of other agents

66
Q

clozapine has more effect on mania or depression?

A

depression

67
Q

risperidone is more antidepressant or antimanic?

A

antidepressant

68
Q

hypothesis of antimanic action

A

dopamine blockade

69
Q

omega 3 MoA

A

dampen signal transduction mechanisms

Psychopharmacology (22 decks)

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