Block 2: Anti-Depressants: Choice Of Ad And Tx Of Bipolar Ds

Front 1

How long do all ADs require to take clinical effect?
How long can they be maintained?

Back 1

2-6 wks
12 mo

Front 2

TCAs vs SSRIs
longer history?
proven efficacy in severe depression?
better side effect profile?
much less toxic?
patient acceptance?
first line ADs for most physicians?

Back 2

longer hx- TCA
proven efficacy- TCA
better side effects- SSRI
less toxic- SSRI
patient acceptance- SSRI
first line AD- SSRI

Front 3

What type of TCA has lower incidence of side effects?

Back 3

Secondary amines (nortriptyline)

Front 4

Give an example of a different side effect profile that may inc pt. acceptance

Back 4

buproprion has lower incidence of sexual side effects- inc's acceptance

Front 5

If poor response, consider "5 D's"...what are they?

Back 5

Dose
Duration
Diagnosis
adjunct Drugs
Different tx

Front 6

What's your best bet with atypical depression (agitation, wt gain, somnolence)

Back 6

MAOIs

Front 7

For severe depression unresponsive to pharmacotherapy, or for psychotic depression, what is recommended?

Back 7

ECT and psychotherapy

Front 8

What two classes of drugs are used to treat acute manic episodes?

Back 8

antipsychotics
and
anticonvulsants

Front 9

What are the classic and more recent antipsychotic drugs used to treat acute manic episodes?

Back 9

classic- haloperidol
recent- olanzapine (Zyprexa)

Front 10

What are the classic and more recent anticonvulsant drugs used to treat acute manic episodes?

Back 10

classic- bezodiazepines (lorazepam, clonazepam, diazepam)
recent- valproic acid (Depakote), carbamazepine (Tegretol)

Front 11

What classes of drugs are used for maintenance of manic depression (mood stabilizers)

Back 11

Lithium
Antidepressants
Anticonvulsants

Front 12

Do most patients require AD?

Back 12

no, severely depressed might
-precipitation of mania can occur in minority of patients

Front 13

What are the common anticonvulsants used for maintenance of bipolar affective disorder?

Back 13

valproic acid (aka divalproex sodium- Depakote)
carbamazepine (Tegretol)

Front 14

What are two theories of mechanism of action of lithium?

Back 14

1. interferes with metabolism of inositol phosphates
2. inhibits glycogen synthase kinase 3

Front 15

Give three uses of lithium

Back 15

1. long-term maintenance of bipolar disorder
2. adjunct in unipolar depression
3. adjunct in schizoaffective disorder
NOT EFFECTIVE IN ABATING ACUTE MANIC EPISODE

Front 16

Name neurologic/psychiatric adverse effects of lithium

Back 16

tremor (tx w/ beta blockers)

also ataxia, hyperactivity, aphasia, sedation, fatigue

Front 17

Name glandular adverse effects of lithium

Back 17

edema from inc aldosterone secretion

also mild hypothyroidism

Front 18

Name Renal adverse effects of lithium

Back 18

polydipsia, polyuria- nephrogenic diabetes insipidus (responds to amiloride)

also degenerative and infl changes in nephron

Front 19

Name GI adverse effects of lithium

Back 19

GI irritation

also diarrhea, and wt gain in some

Front 20

What can lithium do to skin?

Back 20

exacerbate skin problems- psoriasis, acne, folliculitis

Front 21

Does lithium have a high or low TI?

Back 21

low

Front 22

Name signs of lithium overdose

Back 22

mental confusion, aphasia
ataxia, hyperactivity, bizarre motor movements
hypotension, arrhythmias
convulsions, coma

Front 23

How do you treat lithium overdose

Back 23

supportive
osmotic diuretic
dialysis

Front 24

lithium is absorbed (poorly/well)
distributed in ...
and _% is excreted in urine

Back 24

well
total body water
5%

Front 25

What percentage of filtered lithium is reabsorbed?
What can change that?

Back 25

80%
Na levels and age

Front 26

What is the implication of lithiums short t1/2 and low TI?

Back 26

must give in divided doses or controlled-release form

Front 27

How do you know if you reached your lithium target of .5-1 mEq/L

Back 27

blood levels must be determined

Front 28

What drugs will increase lithium toxicity?

Back 28

sodium depleting diuretics that decrease Li excretion- especially THIAZIDES, also furosemide; ACE inhibitors, NSAIDS

Front 29

What can decrease Li levels from increased excretion?

Back 29

mannitol
acetazolamide
theophylline

Front 30

Which of the following anticonvulsants is used only as an adjunct to lithium?
carbamazepam
clonazepam
valproate

Back 30

clonazepam

*the others may be used alone in milder forms of disease*