Therapeutics of Bipolar Disorder Flashcards Preview

NeuroPsych > Therapeutics of Bipolar Disorder > Flashcards

Flashcards in Therapeutics of Bipolar Disorder Deck (45):
1

DSM IV Criteria for Manic Episode

3+ sx >1week persisting all day long

2

Sx: DIG FAST

Distractible
Impulsive
Grandiosity
Flight of ideas
Activities = risky
Sleep = none
Talkative

3

Bipolar I

Manic > depressive

4

Bipolar II

Manic < depressive

5

Which state do most bipolar patients spend their lives in?

Depressive

6

3 Classes of Mood Stabilizers

Lithium
SGAs
Anticonvulsants

7

What is the onset of effect of Lithium for mania vs depressive episodes?

Mania: 7-14 days
Depression: 6-8 weeks

8

Lithium Pregnancy Category and why

D - heart defects

9

Lithium significant kinetics

Absorbed readily - not bound
Distributed widely
Linear kinetics
Renally excreted

10

Lithium TDM

Maintenance range: 0.6-1.2
Acute mania range: 1-1.2
>1.2 = NV, diarrhea, tremor, MS changes then seizure and death

11

Lithium Toxicity

Mild: hold dose and get level
Sever: hold dose, get level, hydration, O2, monitor regularly and get labs

12

Lithium Side Effects

NV: Take with food
Tremor: decrease dose
Weight gain: diet and exercise
Polyuria: decrease dose
Hypothyroidism: synthroid
Acne: topicals
NEPHROTOXIC

13

Lithium Monitoring

Labs
Levels 5-7 days after dose adjustments
Levels and labs every 6 months

14

Drugs Increasing Li Levels

NSAIDs, thiazide diuretics, loops, ACEis

15

Drugs Decreasing Li Levels

K+ sparing diuretics, loop diuretics, theophylline, caffeine

16

Depakote Preferred Use

Mix episodes

17

Depakote Onset

Mania: 3-5 days

18

Depakote Kinetics

Absorbed readily
Highly protein bound
Hepatic excretion

19

Depakote Pregnancy Category

D: neural tube defects

20

Depakote TDM

At steady state 12 hours after first dose
TD: 50-100mg/L

21

Depakote Side Effects

Tremor, fatigue, NV, weight gain, hair loss, liver and pancreas toxicity, thrombocytopenia

22

Depakote Monitoring

Levels at steady state after adjustments
Levels and Lab every 6 months

23

Drugs Increasing Depakote

Aspirin, warfarin, fluoxetine, risperidone

24

Drugs Decreasing Depakote

Carbamazepine, carbapenems, rifampicin

25

Carbamazepine Onset

Second line
Mania: 7-14 days (like Lithium!)

26

Carbamazepine PK

Erratic absorption
Highly protein bound
Hepatically metabolize
Autoinduction starts <7 days and stops in 3-5 weeks

27

Carbamazepine Pregnancy Category

D: Neural tube defects

28

Carbamazepine TDM

After 5 days (steady state)
After 3-5 weeks (post auto-induction)
Range: 4-12

29

Carbamazepine Side Effects

NV
Blurry vision
Dizzy
SJS
Anemia
Agranulocytosis
Liver failure

30

Carbamazepine CIs

MAOi use
Bone marrow depression
Hepatic failure

31

Carbamazepine Monitoring

HLA - rash
Levels 5 days after adjustments and every 6 months
Labs every 6 months

32

Drugs Increase Carbamazepine

Depakote, CCBs, cimetidine, erythromycin

33

Drugs Decreasing Carbamazepine

Phenobarbital

34

Drug Carbamazepine Affects

Decrease levels of oral contraceptives, theophylline and warfarin

35

Oxcarbazepine Onset

Mania: 7-14 days
NOT FDA approved

36

Oxcarbazepine Pregnancy Category

C!

37

Oxcarbazepine Interactions and Side Effects

Similar but milder than carbamazepine
No autoinduction
CYP inducer - decrease oral contraceptives
NO TDM

38

Lamotrigine Onset

First line for depressive episodes
Onset: 6-8 weeks

39

Lamotrigine Dosing

SPECIFIC titration schedule
Start over if miss 3-5 doses in a row
With Tegretol: double dose
With depakote: 1/2 dose

40

Lamotrigine Pregnancy

C (maybe cleft palate)

41

Lamotrigine Side Effects

NV
Fatigue
SJS
Rash

42

Lamotrigine Monitoring

Labs every 6 months
No TDM

43

SGAs Onset

3-5 days
Emergency management of agitation

44

First Line Acute Mania

Lithium
Depakote
Atypical antipsychotics

45

First Line Acute Depression

Lithium
Lamotrigine
Zyprexa and SSRI
Seroquel