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31 Cards in this Set
- Front
- Back
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Bipolar is associated with increased risk of what? |
Substance use Anxiety Suicidality |
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Which bipolar disorder may have sx of hallucinations? |
Bipolar I |
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How long must the mania persist for it to be classified as a manic episode in bipolar I? How long must hypomania persist? |
Mania: ≥ 1 week Present most of the day Nearly every day
Hypomania: 4 consecutive days |
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What is a distinguishing feature between mania and hypomania? |
Mania will likely require hospitalization to prevent harm to themselves or others |
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How do you distinguish bipolar depression from unipolar depression? |
-Fam hx of bipolar -Onset before age 25 -Increase freq of depressive episodes -Poor response to antidepressants in the past
*Suicide rate is DOUBLE that of unipolar depression* |
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In bipolar depression, which receptors are up-regulated? |
DA NE (lack of stimulation causes increased sensitivity and up regulation) *same receptors as depression* |
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In bipolar and unipolar depression, what is the status of serotonin? |
Low (less travel across the BBB, less 5HT in CSF, less 5HT transporters) |
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Where are the alpha 2 receptors located? |
Pre-synaptic (The only NE receptors that are pre-synaptic) |
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Role of dopamine in bipolar |
Excess most likely related to mania Deficits most likely related to depression |
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Initial dosing for Lithium |
Start at 600-900 mg/day Use carbonate form (longer acting) |
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Target level for Lithium |
0.6-1.2 mEq/L |
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2nd line for bipolar disorder |
Valproic Acid |
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MOA of valproic acid |
Increases GABA levels Block sodium channels |
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MOA of carbemazepine |
Prevents release of calcium from neurons Blocks sodium channels |
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Which enzymes are induced with carbemazepine? |
CYP: 3A4 UGT 1A2 2D6 |
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What is the main SE that we are concerned about with oxcarbazepine? |
Hyponatremia
Also: dizziness, tremor, GI upset, rash |
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Use of Lamotrigene in bipolar and MOA |
Maintenance (to prevent acute episodes)
MOA: Block calcium channels Block sodium channels Prevent excess excitotoxicity from excess glutamate release |
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Dosing of Lamotrigene is affected by which other drugs? |
Valproic acid- will need lower dose (25mg qod) Carbemazepine or phenytoin- will need higher dose (25mg bid)
Hormonals and OCP- may need higher dose |
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Use of Resperidone in bipolar |
Monotherapy: acute mania or mixed ep. LAI: maintenance therapy
Adjunct: Same as above, combo with lithium or valproate |
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Which is the "most typical" of the atypical meds for bipolar? |
Risperidone |
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What is Paliperidone? |
Active metabolite of Risperidone Only FDA approved for schizophrenia |
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SEs of Risperidone |
Metabolic Extrapyrimidal |
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Which drug can be combined with an antidepressant for tx of bipolar? |
Olanzapine + Fluoxetine Treats bipolar depressive episodes |
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Which drugs can be used for acute tx of agitated behavior in bipolar? |
Olanzapine (IM) Aripiprazole (IM)- BP1 |
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When do we use Lurasidone (Latuda)? |
Bipolar depression! |
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Major SE of Lurasidone (Latuda) |
Akathesia |
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Which type of drug would need to be discontinued prior to treating an episode of acute mania? |
SSRIs (taper over 3-5 days if necessary) |
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Which drugs can be used for bipolar depression? |
Lurasidone (Latuda) Quetiapine Olanzapine + Fluoxetine |
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What type of drug can potentially increase Lithium levels? |
Thiazide diuretics (loop diuretics seem to have minimal effect) |
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What can potentially decrease levels of Lithium? |
Caffeine |
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Which population is at high risk of SEs with Carbemazepine? |
Asian descent- need genetic testing |
