Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Neuro Quiz 4 > Treatment of Bipolar Disorder > Flashcards

Treatment of Bipolar Disorder Flashcards

(52 cards)

Start Studying
1
Q

Medical Conditions that cause Mania

A 
Hyperthyroidism
Addison's/Cushings disease
AIDS
Neurosyphilis
Epilepsy
Post-stroke
Head injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Substance Disorders that cause mania

A

Alcohol
Hallucinogens: LSD, PCP
Anabolic steroids
Methamphetamine/cocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Meds that cause mania

A 
Antidepressants
Clonidine withdrawal
Beta 2 agonist
BZD withdrawal
Sympathomimetics
PK's meds
Corticosteroids
ADHD
Caffeine and theophylline
Thyroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Mania DSM-5 Criteria

A 
>1 week of abnormal increased mood (expressive or irritable) associated with 3 of the following 
- Increased self-esteem
- Decreased need for sleep
Increased talking or pressured speech
- Racing thoughts
- Poor attention
- Increased activity or agitation
- Excessive involvement in high risk for serious consequences
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Manic episodes cause:

A

Impairment of daily function or cause the patient to be hospitalized due to psychiatric symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hypomania DSM-5 Criteria

A

Same as manic by symptoms are less severe

  • Do not impair daily function
  • Observed for at least 4 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bipolar I is diagnosed if:

A

Full manic episode in their lifetime

- May or may not have had depressive episodes (although most do)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bipolar II is diagnosed if:

A

Has both hypomanic and depressive episodes in their lifetime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Specifiers with Mixed Features

A

Switches back and forth from mania/depression
Nearly every day for at least 1 week
Do impair daily function/hospitalized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Specifiers with Rapid Cycling

A

> /= 4 depressive or manic episodes in 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Goals of therapy for BD

A 
Resolve symptoms
Prevent future episodes
Minimize ADE
Increase compliance
Pt and family education
Avoid stressors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment options

A

ECT
Psychotherapy
Pharmacotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Electroconvulsive Therapy use

A

Mania and depressed episodes
Treatment of resistant symptoms or severe suicidal ideation
PREGNANT
- Causes a seizure for 1 minute and treated 6-12 times

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Psychotherapy:

A

Cognitive Behavioral Therapy
Interpersonal therapy
Group therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Traditional Mood Stabilizers

A

Lithium
Divalproex/valproic acid
Carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pharmacotherapy options

A

Traditional mood stabilizers
2nd Gen Antipsychotics (atypical)
Lamotrigine
Antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Acute Manic Episode Treatment

A 
Mood stabilizer (traditional and atypical)
- Antipsychotics for hallucinations/delusions
BZD short therapy to induce sleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Acute Depressive Episode Treatment

A 
Mood stabilizer (Li, lamotrigine, atypicals)
- Antidepressants = adjunct maybe?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Maintenance Phase Treatment

A

Drug used to treat the most recent acute mood episode to be continued

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

First Line Drugs in Acute Manic Episode

A 
Li
Divalproex
Olanzipine
Risperidone
Quetiapine
Aripipazole
Ziprasidone
Asenapine
Paliperidone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

First line Combo Therapy in Acute Manic Episode

Study These Flashcards
A

Lithium or divalproex + risperidone, quetiapine, olanzapine, aripipirazole, OR asenapine

22
Q

First line Drugs in Acute Depressive Episodes

Study These Flashcards
A

Li
Lamotrigine
Quetiapine

23
Q

First line Combo Therapy in Acute Depressive Episodes

Study These Flashcards
A

Li or divalproex + SSRI
Olanzapine + SSRI
Li + Divalproex
Li or divalproex + bupropion

24
Q

Acute Mania Therapeutic range for Lithium

Study These Flashcards
A
  1. 8-1.5 mEq/L

- Increased Li excretion

25
Maintenance Therapeutic range for Lithium
0.6-1.2 mEq/L
26
When do you obtain steady state concentration for Lithium
5 days and once on maintenance, Q6 months | - 12 hours after the last Li dose
27
5 day follow up always after:
Dosage change Add or d/c a drug that interacts Renal function change Predisposing factors for toxicity
28
Valproic acid/Divalproex Therapeutic level
50-125 mcg/mL | - Draw levels right BEFORE dose
29
Carbamazepine therapeutic concentration
4-12 mcg/mL | - Draw levels right BEFORE dose
30
Carbamazepine PK
Food increase bioavailability | Metabolized by 3A4!!!
31
Lamotrigine Drug concentration
Not necessary
32
Lamotrigine + what can cause problems?
Valproate inhibits metabolism; so start low and titrate conservatively
33
Mild Lithium Toxicity
``` 1.2-1.5 mEq/L Memory difficulty Tremor Weakness Fatigue ```
34
Moderate-Severe Lithium Toxicity:
``` 1.5-3.0 mEq/L Confusion Lethargy Ataxia Emesis Tremors ```
35
Severe Lithium Toxicity
>3.0 mEq/L Irreversible brain damage Respiratory complication Coma and death
36
Monitoring with Li
``` CBC (leukocytosis) Sodium Calcium (hyperparathyroidism) Thyroid (hypo) SCr and BUN (dysfunction) Urine omolality (nephrogenic diabetes) Weight gain EKG (QT prolong) ```
37
Lithium Drug interactions
- No CYP | Avoid diuretics, ACEi, NSAIDs because of sodium
38
Lithium is CI in:
Pregnancy Renal disease Cardiac disease
39
Divalproex AE
Sedation, dizziness | PCOS (polycystic ovarian syndrome)
40
Divalproex Monitoring
Liver function (hepatotoxicity) CBC (thrombocytopenia) Weight Gain Ammonia levels
41
Divalproex Interactions
Hepatic enzyme inducers or inhibitors | Valproate decrease clearance
42
Divalproex CI
Pregnancy Thrombocytopenia Liver disease Pancreatitis
43
Carbamazepine AE
Sedation/dizziness SJS!!! Osteopenia Agranulocytosis
44
Carbamazepine Monitoring
``` Agranulocytosis Liver function (hepatotoxicity) Sodium HLA-B 1502 (SJS) Take with food!! ```
45
Carbamazepine Interactions
Autoinduces its' own metabolism aka hepatic enzyme inducer Other inducers Increases clearance of contraceptives Valproate inhibits breakdown
46
Carbamazepine CI
Pregnancy Immunocompromised Liver disease
47
Lamotrigine AE
SJS | Diplopia, headache
48
Lamotrigine Monitoring
Rash
49
Lamotrigine Interaction
Inducer = increased clearance Valproate decrease glucuronidation (rash) Autoinducer of its' metabolism Oral contraceptives can decrease concentration
50
Caution with antidepressants in BD
Risk of switching to a manic state esp Bipolar I (higher with TCAs and SNRS)
51
Risk of switching = higher in:
Higher in Bipolar I Recent manic or hypomanic episode Concurrent substance abuse Greater # = higher risk
52
Recommended Antidepressant in BD
Concurrent use with mood stabilizer | - Pts who respond quickly to antidepressant are more likely to relapse if it is d/c

Neuro Quiz 4 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions