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29 Cards in this Set
- Front
- Back
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Bipolar I vs. bipolar II
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I:1 or more manic or mixed episodes + major depressive --> can require hospitalization
II: 1 or more major depressive + 1 hypomanic episode |
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What are the 4 subtypes of bipolar?
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Bipolar I, Bipolar II, Cyclothymic disorder, non specific (NOS)
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Cyclothymic disorder is characterized how?
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2 or more years of hypomania or depressive sx; do not meet major depressive or manic episodes
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Manic episode
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at least 1 wk of abnormal and persistent elevated mood
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Major depressive
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>2 wk period of depressed mood or loss of interest or pleasure in normal activities
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Recurrent depressive episodes are more common in ___.
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women
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What medical conditions can induce mania?
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CNS disorders, infections, electrolyte or metabolic abnormalities, endocrine or hormonal
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What is the average length of untreated manic episodes?
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4-13 months
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What is the monoamine hypothesis?
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Mania: excess DA or NE
Depression: deficit of DA, NE, or 5HT |
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What is the second messenger hypothesis?
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-abnormal G protein --> dysreg adenyl cyclase
-abnormal PI responses -abnormal Na/K/Ca exchange and phospholipases -abnormal cAMP and PI 2nd messenger activity -decreased arachidonic acid |
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T/F. Lithium is an acute treatment with antipsychotic drugs.
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True
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Daily dose of lithium? Effective plasma levels?
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1-2 grams
~1 mM |
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Elimination of lithum
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via urine, prominent reabsorption in kidneys
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If Li levels rise, then Na levels ___.
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falls; inverse proportion
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Li uncompetitively inhibits ___ of IP3.
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dephosphorylation
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What are 3 proposed MOA of Li?
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1. inositol depletion
2. down regulation of Gs/Gi protein 3. inhibition of glycogen synthase kinase |
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Which Li ADRs are transient?
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lethargy/muscle weakness and edema
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What is the treatment for Li?
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hemodialysis
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If Li is >3.5 mM, what can happen?
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coma, convulsions
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Valproic acid is a substrate for which enzymes?
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2C9 and 2C19
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Carbamazepine MOA
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blocks Na channels from recovery --> delays depolarization of cell membrane
-affects inositol |
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Which drug is autoinduced?
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carbamazepine
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Carbamazepine is primarily metabolized by what enzyme?
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3A4
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What are some chronic ADRs of carbamazepine?
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diplopia, hematotoxicity, hypoNa and water retention, SKIN RASHES
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Which drug has genetic susceptibility and can be screened?
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carbamazepine, HLA-B 1502
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Lamotrigine MOA
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blocks Na channels from recovery --> delays depolarization of cell membrane
-decrease release of glutamine |
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Valproate decreases the clearance of what drug?
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lamotrigine
-can cause severe hypersensitivity reactions |
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Which drug is similar to carbamazepine and is a prodrug?
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oxcarbazepine
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The active metabolite of oxcarbazepine is excreted ___ or in the form of ___.
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unchanged or glucuronide
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