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50 Cards in this Set

  • Front
  • Back
What is the definition of a manic episode?
characterized by at least one week of an abnormal and persistently elevated mood
What are symptoms of a manic episode?
• decreased need for sleep
• flight of ideas
• inflamed self-esteem
• increased hyperactivity or agitation
• pressured speech
• poor attention
Name and describe the two types of bipolar disease
• Bipolar I: presencve of manic episodes and usually includes major depressive disorders

• Bipolar II: presence of major depressive episodes and hypomanic episode (no psychotic episode & lower degree of impact on functioning)
What are some causes of bipolar disorder?
• changes in electrolytes and cell membrane theories (ex. decrease in Ca++)
• genetics
• neurotransmitters (ie. too much serotonin can block dopamine)
• neuroendocrine theory
• seasonal or environmental (ex. SAD-seasonal affective disorder)
What are the target symptoms of bipolar disorder that we want to affect?
• Mood (happy, friendly, easily distracted, increased mood)
• Cognitive and perceptual symptoms (hallucinations)
• Activity & behavior (risk takers, suicidal ideations, might hurt others)
What is the MOA of Lithium?
• MOA is unknown
• presumed MOA: attenuation of dopamine function, facilitation of GABA function, & alteration of serotonin function
True/False: Lithium is an effective drug for a patient who with an acute period agitation and without a history of psychiatric disorder (bipolar).
• Lithium takes about 1-2 weeks to become effective. If the patient has no history of psychiatric disorder and was never on Lithium before, it would not be an effective agent in an acute setting.
• The correct answer is: false
What is the half-life of Lithium?
• 20-24 hrs
• should obtain a level 4-5 days after starting Lithium
What are the desired Lithium levels for acute mania and maintenance?
• Acute mania: 0.8-1.0 meq/L
• Maintenance: 0.8-1.2 meq/L
What is the inital dosing of Lithium?
1200-1800 mg/day (in divided doses)
What are lab levels that you want order when administering Lithium?
• Before starting: CBC, electrolytes, renal function, thyroid function tests, UA, EKG

• 4-5 days after initiating or after changing dose: monitor CBC and electrolytes
When are side effects from Lithium most common?
during initiating or changing doses
What are some Lithium side effects and what would you do to correct the side effect?
• CNS toxicity (agititation, confusion) » reduce dose
• Hypothyroidism » stop lithium or treat (do not rechallenge the patient)
• Interstitial fibrosis » stop drug or keep at lowest possible dose
• Polydipsia/uria » reduce dose; change to at night dosing
• Rash or psoriasis » stop drug
• Teratogenicity » avoid during first trimester
• Tremor » reduce dose; add beta-blocker (propanolol because it crosses blood-brain barrier)
List drugs that can increase Lithium concentration
• ACE inhibitors
• Thiazides
• Theophylline
What is the effect of Lithium on neuromuscular blockers ?
Lithium prolongs the action of neuromuscular blockers
What is the effect of Lithium on neuroleptics?
Lithium may potentiate EPS (extra-pyramidal symptoms)
What is the effect of Carbamazepine on Lithium?
increases CNS toxicity of Lithium by blocking sodium channels
What is the effect of Lithium on the thyroid gland?
• Lithium decreases synthesis & release of thyroid hormone
• can cause hypothyroidism (usually manifests in 1-2 months)
• get baseline TSH, T3, T4 levels
How does pregnancy affect Lithium?
• pregnancy increases GFR
• can cause decreased Lithium levels (may have to increase dose in 2nd or 3rd trimester)
What is the affect of aging on Lithium?
• aging decreases GFR
• will cause a decrease in Lithium requirements (decrease dosage)
• increased risk of adverse drug effects
How does decreased renal function affect Lithium?
• decreased renal function will cause a decrease in GFR and an increase in creatinine and BUN
• will cause an increase in Lithium concentration
How does dehydration or salt restriction affect Lithium?
• dehydration & salt restrictions will cause an increase in Na+ reabsorption
• will cause an increase in Lithium levels
Why are anticonvulsants used with Bipolar disorder?
they are "mood stabilizers" that reduce manic and depressive episodes
What are common anticonvulsants used in the treatment of bipolar disorder?
• Carbamazepine
• Lamotrigine
• Valproic Acid (Depakote)
What is the MOA of Valproic Acid (Depakote)?
• blocks T-type calcium currents
• blocks sodium channels
• increases GABA production
Is Valproic Acid (Depakote) an inducer or inhibitor?
an enzyme inducer
What are adverse effects of Valproic Acid (Depakote)?
• Alopecia
• Hepatotoxicity
• Nausea/Vomiting
• Pancreatitis
• Weight gain
What are effective uses of Valproic Acid (Depakote)?
• effective in acute and prophylactic management
• good for rapid cyclers (patients with rapid fluctuating moods)
• better than Lithium in rapid cycling patients
What is the desired serum level of Valproic Acid (Depakote) in a patient with bipolar disorder?
45-125 mcg/ml
What is the MOA of Carbazepine (Tegretol)?
sodium channel blocker
Is Carbamazepine an inducer or inhibitor?
• inducer
• can cause autoinduction
What are adverse effects of Carbamazepine (Tegretol)?
• Aplastic anemia
• Anemia
• Hyponatremia
• Leukopenia
• Rash
• Thrombocytopenia
What labs should be monitored for a patient on Carbamazepine?
• LFTs
• Chem-7 (especially Na+ levels)
When can you use Carbamazepine (Tegretol)?
• may be used in acute & maintenance therapy
• can be added to Lithium therapy
What are available formulation of Valproic Acid (Depakote)?
IV or PO
What are available dosage forms of Carbamazepine (Tegretol)?
What is the desired serum level of Carbamazepine (Tegretol)?
4-14 mcg/ml
What are indications for using Lamotrigine?
• only approved for maintenance therapy
• appears to be good for patients in a depressed state
• not widely used
What are adverse effects of Lamotrigine?
Rash (can cause Steven Johnson Syndrome)
List the antipsychotic drugs that are approved for treatment of bipolar disorder
• Ariprazole (Ablify)
• Olanzapine (Zyprexa)
• Paliperidone (Invega)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Ziprasidone (Geodon)
When are the antipsychotic drugs used for bipolar disorder?
only useful during acute episodes while starting or titrating Lithium or mood stabilizers
Which antipsychotic drugs are available in injectable forms?
• Ariprazole (Abilify)
• Olanzapine (Zyprexa)
• Ziprasidone (Geodon)
What precautions should be taken for a patient given Geodon IM?
• patient needs to be on an EKG
• can cause QTC prolongation (may lead to Torsades de Pointes)
When a benzodiazepines useful in patients with bipolar disorder?
• useful only for insomnia, hyperactivity, and agitation
• does not prevent relapses
Which benzodiazepines can be used for acute bipolar disorder?
• Lorazepam (Ativan) and Diazepam (Valium) are used in acute setting for anxiety
• are available in injectable forms
What therapy could be used on a patient with euphoric mania or hypomania?
• Lithium
• Valproic Acid
• Atypical antipsychotics
What therapy could be used on patients experiencing mixed episodes?
Valproic Acid or atypical antipsychotics
What therapy can be used on a patient experiencing psychotic mania?
Lithium, Valproic Acid, or atypical antypsychotics
What therapy can be used on a patient who is depressed?
• optimize mood stabilizers (Valproic Acid)
• do not use antidepressants (ex. SSRI) without a mood stabilizer