Week 3: Bipolar, Anxiety Flashcards

Question

Lithium use in bipolar disorder indication: MOA: Adverse reactions: DDI: contraindicated monitoring:

Answer 1

indication: euphoric mania (not for rapid cyclers or mixed states) MOA: Adverse reactions: a: long term effects on kidneys polydipsia and polyuria w. or w.o nephrogenic diabetes insidious (NDI), AKI, CKD3 reported also b. dose related CNS effects c.muscle weakness d.cardiac effects e. decrease thyroid hormone synthesis contraindications: severe cardiac or renal disease DDI:NSAIDS, ace-I, arbs, diuretics, CCB, d/c lithium 2 days before and after electro convulsive therapy, caffeine monitoring: renal function (SCr, BUN) baseline PE CBC w. differential (reversible leukocytosis) FG, lipids-weight, waist circumference thyroid function test serum electrolytes dermatologic (acne) lithium levels every 3 months

Answer 2

when can it be used? First line for acute mania, acute bipolar depression and maintenance in BPI and BPII. NOT for rapid cycling or mixed states. decreases suicide significantly how to be used? 900-2400mg/kg/day. give with food must maintain good hydration onset for mania 6-10 days and full effect in 3 weeks, >4 weeks for depression what are the side/long term effects? *polydipsia nd polyuria w. or w.o NDI, AKI,or ckd *GI or cns EFFECTS(dose related worst at peak *muscle weekness and lethargy *cardiac effects *decreased thyroid hormone synthesis Floppy baby syndrome what do you have to monitor for? *lithium levels: 0.6-1.2 mEq/L : 1.0-1.2 for acute mood episodes. >1.5mEq/L is toxic (if it is below range and drug still working, no need to increase dose). TDM 8-12 hrs after last dose, at Css. *Renal function:containdicated in severe renal disease *cardiac function: ci in severe cardiac disease *thyroif function *cbc w. differential *FG, fasting glucose, waist circumference (metabolic) *may unmask brigade syndrome(fast irrgefular heart beat) what are interactions? ACE-I, ARBs, NSAIDS, diuretics, blood dyscrasia w. clozapine d/c, ehanced neurotoxicity with electroconvulsive therapy, Methyl-xanthines like caffeine, etc.

Answer 3

indications: fda approved for acute manic and mixed episodes BBW: pancreatitis and/or liver toxicity and urea disorders formulations approved: depakote , depakote ER, Stavzor dose related gi, tremor (can give bb to reduce) sedation (give @hs) dose related alopecia weight gain prolonged bleeding

Answer 4

anticonvulsant FDA approved for maintenance therapy and acute depression dose escalation must be low and slow to decrease risk of SJS Cause less drowsiness than Other agents When combined w. Valproate , lamotrigine dose must be halved

Answer 5

only FDA approved formulation is ER formulation (Equetro) dose can be increased rapidly for inpt. used for acute manic episodes: onset for mani is 7days. not used for maintenance. also sed after 1st line agents CI: can cause neutropenia( bone marrow suppression) leukopenia, hematologist disease, agranulocytosis, patients with positive HLA careful combo use with valproate because valproate can increase levels (also in lamotrigine

Answer 6

SGA may be good for certain episodes, not all FGA good for acute mania use in combo w. lithium or valproate for acute or mixed injectable APS good option for pts. with poor adherence

Answer 7

only used as add on therapy do not use in bipolar disorder alone . may result in switch to mania if in depressed phase

Answer 8

high potency agents like clonazepam or lorazepam can be used during acute mania/ agitation or anxious features/ restore sleep adjustt to response and adverse events used short term avoid in pts with substance use

Answer 9

divalproex: can cause neural tube defects. avoid as 1st line in women who may become pregnant carbamezapine: increased risk of spina bifida. avoid during pregnancy lamotrigine: lower levels during pregnancy lithium: increased doses during pregnancy, use care upon delivery. increased risk of abnormal tricuspid valve.

Answer 10

use an APS along with an agent to treat bipolar. an APS must be present

Answer 11

NSAIDS: increase Li lives ACE/ARBs: increase Li levels diuretics: increase Li levels Methyl Xanthines(i.e caffeine): decrease Li levels

Answer 12

an emotional state commonly caused by the perception of real or percieved danger normal anxiety is an appropriate adaptive response if excessive, can result in significant disability

Answer 13

remission with minimal or anxiety symptoms and no functional impairment

Answer 14

antidepressants. takes atleast 8-12 weeks to take effect. much slower response than when using these agents for depression

Answer 15

excessive difficult to control anxiety and worry about multiple events or activities SS of restlnessneds or feeling on the edge or tension psychological SS: excessive anxiety worries that arre out of control feeling on edge physical symptoms: restlness fatigue muscle tension sleep disturbances irritability impairment: socially accupationally poor coping skills

Answer 16

recurrent expected panic attacks, in absense of triggers . persistent concerns about additinoal panic attacks and/or maladaptive change in behavior related to attacks

Answer 17

markes unreasonable fear or anxiety about a specific situation , which is activdely avoided due to thoughts that escape may be difficult and fear resulting in panic symptoms

Answer 18

marked unreasonable fear or anxiety about a specific object or situation (flying spiders, recieving injection)

Answer 19

marked. excessive unreasonable fear of anxiety about social situations in which there may beb scrutiny by others, which is actively avoided

Answer 20

anticonvulsants: carbamezapine, phenytoin antidepressants: buproprion, SSRI, TCA anti-HTN: clonidine and felodipine abx: quinolones, isoniazid bronchodilators: albuterol, theophylline corticosteroids: prednisone dopamine agonists: amantadine, levedopa herbal agents: ginseng, ephedra, ma huang illicit substances: cocaine, ectasy, THC stimulants: methylphenydate, caffeine, nicotine toxicity: anticholinergics, digoxin withdrawal: includes sedatives

Answer 21

persistent symptoms for most days for at least 6 mo. and worry is unrealistic or excesive about a number of events or activities gradual onset w. avergae onset @age21 women more likely than men

Answer 22

long term: remission, prevent occurance acute: decrease severyity and duration of symptoms, increase function at all times: decrease ADR, increace adherance non pharm: CMT, psychoeducation avoid stimulants and alcohol

Answer 23

antidepressents: treatment of choice APS and antihistimaines: high incidence of ADR and toxicity,

Answer 24

FDA approved SSRI's *Escitalopram (Lexapro) *Paroxetine (Paxil) SNRI's *Duloxetine(Cymbalta) *venlafaxine XR NON FDA APPROVED: SSRI:sertraline AntiEpileptic: Pregablin

Answer 25

lag time of 2-4 weeks OR LONGER b4 any antianxiety effects efficacy can take 8-12 weeks start low and go slow, with gradual taper response to treatnment described as improved, partial response after 4-6 weeks. if partial response, confirm adequacy of trial and consider augmentation, or switch AD after adequate trial , continue for atleast 1 year

Answer 26

BBW: increased risk of suicide in ppl

Answer 27

BBW: increased risk of suicide in ppl

Answer 28

hydroxyzine FDA approved second line agent beers list

Answer 29

BBW: increased risk of death in use in elderly w. dementia related psychosis: NOT for elderly pts who are being treated long term for another idnicatino like schizophrenia quetiapine second line agent ziprasidone not recommended

Answer 30

not a confirmed BBW, but increased risk of suicidal thoughts

Answer 31

sleep disturbance: evaluate and mange causes more sedating agants such as pregablin or hydroxyzine elderly pts: consider sertraline or escitalopram, beers list neuropathic pain: consider pregablin

Answer 32

provide rapid releif of symptoms 2-3 weeks. NOT EFFECTIVE for depression long term use asocitaed w. phsyical and mental dependence ci: allergy to bxd, hx of substance use, myasthenia gravis, severe hepatic disease, resp. disease, narrow angle glaucoma BBW: ins=creased risk of death when used in combo with opiates. ALSO risk of abuse, misuse, and addiction risk of rebond anxiety w. quick d/c inceeased risk of seizures after d/c from high dose benzo and use of AED d/c taper example: 25% [er week reduction until 50%, then decrease dose by 1/8 q4-7 days fo rtherapy >8 weeks taper over 2-3 weeks for therapy >6mo. taper over 4-8 weeks. if greater than 1 year, over 2-4 MONTHS elderly ptsa increased risk of falls b/c of increased conc.

Answer 33

CLAD Clorazepate: needs acid Lorazepam: Over the liver (OTL), less lipophilic, longer duration of action Alprazolam (Xanax):HIGH POTENCY. available as ODT Diazepam: euphoria, misuse, more lipophilic, faster rate of absorption and short duration of action

Answer 34

a series of unexpected, spontaneous attacks of intense terifying fear attack is followed by at least 1 month of having persistent fear attack last 20-30 min but highest intensity in first 10 min

Answer 35

psycho: fear of losing control fear of going crazy fear of dying depersonalization de-realization phsyical: gi distress chestpain/ disocmforrt chills/hot flashes dizziness palpitations sob trembling shaking sweating

Answer 36

being in atleats 2 situations or places where escape is difficult cause pts. to avoid situations

Answer 37

treatment of choice: antidepressants

Answer 38

start low and go slow with dosing (up to 1/2 of doses used for depression, esp, with SSR and SNRI antidepresssant therapy may take 8-12 weeks to see full efficacy

Answer 39

FDA APPROVED SSRI fluoxetine paroxetine sertraline SNRI: venlafaxineXR NON FDA approved citalopram escitalopram fluvoxamine

Answer 40

buspirone (due to slow onset of action) propanolol tiagbine trazadone

Answer 41

same as GAD long term: remission, prevent occurance acute: decrease severyity and duration of symptoms, increase function at all times: decrease ADR, increace adherance non pharm: CMT, psychoeducation avoid stimulants and alcohol

Answer 42

can be used as a first step if there is an urgency and no delay in relief is possible high potency bzd are preffered such as alprazolam and clonazepam, but lorazepam and diazepam can also be used

Answer 43

buspirone, trazadone, buprorpion, , APS, beta blockers and antihistamines shown to be INEFFECTIVE buspirone has NO antidepressant effects

Answer 44

edlerdy: less and fewer intense attacks children: tend to have fear of dying and agoraphobia in general SSRI best choice

Answer 45

persistent fear of object or situation

Answer 46

unresponsive to drug therapy highlighy response to CBT

Answer 47

intense fear by intense, irrational and persistent fear of being scrutinized or judged in social settings or performance situations

Answer 48

mean age is mid teend SAD higher in women mean age 20 year course

Answer 49

ADULTS <18 Y.O. SS for atleast 6 mo to meet dx criteria feers: judged by others embarassed humiliated addressing group of ppl eating or writing infront of tohers interacting with authority speaking in public talking to strangers use of public facilities

Answer 50

long term: remission, prevent occurance acute: decrease severyity and duration of symptoms, increase function at all times: decrease ADR, increace adherance non pharm: CMT, psychoeducation avoid stimulants and alcohol

Answer 51

antidepressants

Answer 52

FDA approved: SSRI: *paroxetine Sertraline SNRI Venlafaxine non FDA approved escitalopram fluvoaxamine

Answer 53

busprinone, atenelol, levetiracetam, quetiapine, propanalol (only if symptoms are present)

Answer 54

elderly: pk/pd changes, organ function, increased risk of falls and sensitivity etc. children: cbt is a good treatment option.. pregnancy: do not use paroxetine:

Answer 55

non pharm theapy options are best... such as cbt and eye movement desensitization SSRI's and venlafaxine first line pharm treatment options BENZOS are not recommended prazosin and clonidine for PTSD related nightmares

Answer 56

FDA Approved ssri: paroxetine serttraline WSNRI: venlafaxine non fda approved: fluoxetine

Answer 57

exposure to a traumatic event response to event must incude intense horror, fear, or feelings of helplessness pt must have one intrusion symptom, 1 avoidance, and 2 symptoms of negartive alterations in cognition must cause significant distress or impairment of dysfunction

Answer 58

DO NOT GIVE BENZOS can impair cbt effectiveness

Answer 59

for pts with persistant symptoms

Answer 60

SSRI treatment of choice alone or with CBT augmentation of ssri w. low dose APS may be helpful non pharm: cbt exposure

Answer 61

fluoxetine (prozac) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline(Zoloft)

Week 3: Bipolar, Anxiety Flashcards

(85 cards)