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57 Cards in this Set
- Front
- Back
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bipolar
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imbalance of neurotransmitters
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manic episode
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elevation in norepi
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depression
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dec norepi
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dysregulation of GABA
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deficiency in GABA -> mania due to unopposed excitatory neurotransmitters
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GABA
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inhibitory neurotransmitter
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unopposed excitatory neurotransmitter
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dopamine
norepi |
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Ca conc in CSF
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effect the exitability of neurons
factor in depression to mania |
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G proteins
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signal transduction and activation of 2nd messenger sys for var neurotransmitters
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hyperactive G proteins
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mood instability
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G proteins + glutamate
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long term potentiation and cycling of mood disorders
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inhibit G protein linked mechanism
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Lithium
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sx of mania
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grandiose ideations
expansive self esteem pressured speech racing thoughts flight of ideas distratability psychomotor agitation engaging in dangerous and high risk activities |
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mixed episode
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coexistence of manic and depressive sx for at least 1 week
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mood incongruent
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asa mixed episode
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bipolar 1 disorder
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at least 1 manic or mood episode
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bipolar 2 disorder
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never exp a manic episode
exp 1 or more depressive episodes exp 1 hypomanic episode |
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cyclothymia
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depressive and hypomanic sx persist for 2 yrs
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rapid cycling
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dx when pt has exp at lest 4 depressive,manic,hypomanic or mixed episoded w/in 12 mo period
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primary agts in trmt of bipolar
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lithium
anticonvulsants |
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mood stabilizers
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anticonvulsants
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olanzapine
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only atypical antipsyc for trmt of acute mania
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alternative to olanzapine
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risperidone
quetapine ziprasidone |
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first line agts bipolar trmt
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lithium
lamotrigine |
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1st line due to less risk for mania
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bupropion
paroxetine |
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lorazepam
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short term mgmt of acute agitation assoc w/ mania
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lithium indication
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1st line therapy for trmt and prevention of bioilar except in mixed episodes or rapid cycling
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lithium chemistry
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monovalent cation
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2 clinically relevant lithium salts
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lithium carbonate
lithium citrate |
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food
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delay absorption but does not affect the extenet of absorption
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distributes into total body water and penetrates many body tissues
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lithium
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lithium clearance directly proportional
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GFR
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not metabolized and its primarily eliminated thru kidneys
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lithium
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lithium moa
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affect membrane stabilization
augment homeostasis by enhancing the fxn of 2ndary messenger sys |
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secondary messenger sys
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cyclic adenosine monophosphate
cyclic guanosine monophosphate phosphatidylinositol |
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inhibit norepi release and accelerate its metabolism
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lithium
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dec rec sensitivity and inc presynaptic reuptake of norepi and 5HT
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lithium
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lithium therapeutic range
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0.5 - 1.5 mEq/L
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valproic acid - vpa
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anticonvulsant
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vpa indication
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acute mania
mixed mania rapid cycling |
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vpa moa
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related to gaba modulation and 2nd messenger sys
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vpa drug interaxn
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cimetidine
chlorpromazine erythromycin delbamate salicylates |
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dec vpa conc
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rifampin
pehnobarb lamotrigine phenytoin cbz |
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inc warfarin and zidovudine
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vpa
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lab test for vpa
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cbc
liver fxn test |
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cbz indication
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anticonvulsant
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cbz moa
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modulate norepi and G protein bound linked 2nd messenger sys - cAMP
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cbz se
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induces enzymatic metabolism
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monitor for cbz
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serum conc
drug interaxn |
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lab test for cbz
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cbc
liver fxn test thyroid stimulating hormone electrolytes bun creatinine |
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newer mood stabilizer
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lamotrigine
gapapentin oxcarbazepine |
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lamotrigine chemistry
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similar to phenytoin and cbz
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lamotrigine moa
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blk Na mediated release of glutamate and aspartate at low conc
high con - blks gaba and acetylcholine release |
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gabapentin adv eff
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somnolence
nystagmus dizzy ataxia fatigue |
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oxcarbazepine
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alternative to cbz
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leukocytosis
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lithium
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leukopenia
bld dyscrasia |
cbz and vpa
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birth defects
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lithium
vpa cbz |
