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31 Cards in this Set
- Front
- Back
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Describe DSM-IV's criteria for Bipolar diagnosis:
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--Period of abnormally elevated/irritable mood for >1 week
--At least 3 symptoms off of list --Symptoms do not meet criteria for mixed episode --Mood disturbance cause severe impairment in daily functioning --Symptoms are not secondary to substance use or medical condtion |
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List 7 seven symptoms associated with DSM-IV's Bipolar:
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Increased self esteem/grandiosity
Increased talking Increased activity Flight of ideas Decreased need for sleep Decreased judgement Distractible |
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Describe the two types of Bipolar (1, 2)
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Bipolar I: mood disorder with 1+ manic/hypomanic and 1+ depressive episode followed by symptom free periods (pt is typically hospitalized in the manic state)
Bipolar II: recurrent depressive episodes with hypomania, usually does not require hospitalizations (pt is typically hospitalized in the depressed state) |
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Identify and explain two subtypes of Bipolar:
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Rapid Cycling: 4+ episodes per year, usually women, ADs can worsen
Mixed: simultaneous episodes of mania and depressive symptoms |
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Briefly explain the pathophysiology of Bipolar:
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decreased 5HT and increased NE
decreased GABA increased glutamate molecular changes (Na and Ca channels) |
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List symptoms of Bipolar disorder:
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--changes in sleep patterns
--racing thoughts --overconfident --irrational decisions (increased spending, increased sexual activities, major life changes) --grandiosity --increased activity --labile --pressured speech |
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With Bipolar, which type of episode usually occurs first?
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manic
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Using a graph of mood, what is the goal of Bipolar treatment?
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Goal is not to flatline patient; mellow out peaks and valleys.
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Describe Lithium
(indication, MOA, t1/2, elimination, time to SEs) |
--classic mania
--effects anion exchanged and sodium transport in the nerves, normalizes synaptic transmission of NE, 5HT, and DA --24 hrs --100% renally eliminated --side effects in 5-10 days |
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When do we want to draw a Li level?
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12 hours after 5th dose
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What seven things do we like to test prior to starting Li therapy?
Which two don't we check after baseline? How often do we check these? |
-serum electrolytes
-ECG -BUN/Scr -TSH -Urinalysis -Pregnancy Test -CBC Pregnancy and ECG q3months for first 6 months then every 6 months |
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List common early and persistent side effects of Li therapy:
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Early: N/V, diarrhea, stomach pain, fine hand tremor, fatigue, polyuria/polydipsia
Persistent: hand tremor, polyuria, increased WBC, acne, weight gain, hypothyroidism |
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How do we manage the following Li side effects:
Tremor Polydipsia GI Weight Gain Hypothyroidism Acne |
Tremor: decrease dose, HS dosing, SR, avoid caffeine, propranolol
Polydipsia/polyuria: decrease dose, HS dosing, SR GI: take w/ food, capsules, SR, decrease dose, HS dosing Weight gain: diet, exercise, d/c Hypothyroidism: thyroid supplement Acne: topical antibiotics, retinoic acid |
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Is Li teratogenic?
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Yes
freely crosses the placenta, avoid use in pregnancy (especially 1st trimester) |
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List mild and moderate-severe toxicity side effects of Li:
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mild: more severe hand tremor, reappearance of GI symptoms, confusion, ataxia, slurred speech
moderate: tremor, seizures, coma, hyperreflexia, CV collapse, death |
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List several advantages of Li therapy:
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--will control a manic patient without a drugged effect
--will normalize mood --very good prophylactically to decrease mood swings --relapses, when they occur, are less severe and usually shorter in duration --blood concentration monitoring allows careful titration to therapeutic concentration --low drug cost |
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List several disadvantages of Li therapy:
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--narrow range of therapeutic blood concentrations, requires close monitoring to prevent toxicity
--patient compliance and understanding of the warning signs of toxicity is important --lag period before therapeutic effect in manic patients --prophylactic effect may take 6 months to 1 year to maximize --rapid cyclers are poor responders --expense of blood levels |
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List several common Li interactions:
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ACE, NSAIDs, Thiazide diuretics, theophylline (decrease Li level), iodides (hypothyroidism), metronidazole
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Explain/describe Valproic Acid, including indication, MOA, metabolism:
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--more effective in rapid cyclers and mixed episodes (effects in 3-5 days)
--enhances GABA activity, effects Na channels --metabolized by liver |
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List common side effects of Valproic acid:
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--GI distress
--sedation --weight gain --alopecia --thrombocytopenia --elevation of LFTs --pancreatitis --hepatooxicity |
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Explain/describe Carbamazepine, including indication, MOA, metabolism and time to effect:
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--more effective in rapid cyclers and mixed episodes
--MOA: inhibits transmission at Na channel --metabolism is by CYP3A4 --time to effect: 1-2 weeks |
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List common side effects of CBZ:
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sedation
ataxia nausea rash hyponatremia aplastic anemia thrombocytopenia |
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Explain the use of LTG to treat Bipolar:
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--indicated for maintenance treatment of Bipolar II disorder. Shown to delay the time of occurrence of mood episodes.
--inhibits voltage sensitive Na channels --titrate slowly to avoid rash --interacts with CBZ and VPA |
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Explain the treatment guidelines for the following:
acute treatment of BP maintenance treatment of BP treatment during depressed phase |
acute: Li, VPA, CNZ, AP, short term use of BZD
maintenance: monotherapy, Li, VPA, LTG Depressed: use AD cautiously, can flip patient into manic phase |
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B/G: quetiapine
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Seroquel
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B/G: olanzapine
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Zyprexa
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B/G: risperidone
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Risperdal
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B/G: paliperidone
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Invega
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B/G: Ziprasidone
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Geodon
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B/G: clozapine
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Clozaril
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B/G: aripiprazole
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Abilify
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