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Flashcards in Bipolar Pharm Deck (43)
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1

What medications can trigger mania?

SSRIs
SNRIs

2

What are the 2 factors that shape treatment of bipolar disorder?

How the patient has been affected by disorder
How the patient will be helped by treatment

3

What should patients be assessed for when presenting with mania?

Suicide risk
Aggressiveness
Risk of violence to others
Ability to adhere to treatment program
Substance abuse evaluation & treatment
Alcohol, caffeine, & nicotine intake

4

What should be discontinued when a patient presents with mania?

Antidepressants

5

Classes of Medications

Mood Stabilizers: lithium, anticonvulsants
First generation antipsychotics
Second generation antipsychotics

6

Mood Stabilizing Agents

Lithium
Valproate (Depakote)
Carbamazepine (Tegretol)

7

What is important in determining which mood stabilizer to use?

Previous history
SE profile
Co-existing medical illness

8

Mood Stabilizing Agent SE

Drowsiness
Dizziness
Headache
Diarrhea
Constipation
Heartburn
Mood swings
Stuffed/runny nose
Other cold-like symptoms

9

Lithium

Decreases frequency & severity of manic & depressive episodes
Decrease norepi and dopamine turnover
Blocks dopamine receptor supersensitivity
Augment synthesis of acetylcholine
May work better in maintenance phase

10

Why Lithium?

Low therapeutic index
Constant blood level monitoring
Renal clearance reduced by diuretics
Tremor common SE
Decreased thyroid function
Polydipsia, polyuria
Edema, weight gain

11

Labs to Monitor Lithium

BUN
Creatinine
Thyroid function tests
Lithium levels

12

Why Valproate (Depakote)

SE profile less than lithium
Quick onset
Increase dose more rapidly
Larger therapeutic window

13

What drug class is valproate (Depakote) in?

Anti-convulsant

14

SE of Valproate (Depakote)

Weight gain
N/V
Hair loss
Tremor

15

Labs for Monitoring Valproate (Depakote)

Liver functions
Platelets
Valproate levels

16

What drug class is carbamazepine (Tegretol) in?

Anti-convulsant

17

SE of Carbamazepine (Tegretol)

N/V
Hyponatremia
Rash (SJS & TENS)
Drowsiness
Blurred vision
Blood dyscrasia's

18

Labs to Monitor with Carbamazepine (Tegretol)

Liver function tests
CBC
Serum sodium
Carbamazepine levels

19

What drug class is lamotrigine (Lamictal)

Anti-convulsant

20

What does lamotrigine (Lamictal) treat?

Bipolar depression without triggering mania, hypomania, mixed states, or rapid cycling

21

What medication is not recommended for treatment of acute mania

Lamotrigine

22

Medications to use in acute severe manic or mixed episodes

Anti-psychotic +
Lithium or Valproate

23

Medications to use in acute moderate manic or mixed episode

Lithium OR
Valproate OR
Antipsychotic agent

24

Examples of First Generation Antipsychotics

Haloperidol (Haldol)
Chlorpromazine (Thorazine)

25

Shortcomings of FGAs

Small percentage of patients helped to recover
Annoying & serious AE

26

AE of FGAs

Akathisia
Parkinsonian-like rigidity & tremor
Tardive dyskinesia
Neuroleptic malignant syndrome

27

Define Akathisia

Subjective feeling of muscular tension which can cause restlessness, pacing, repeated sitting or standing

28

SE of FGA Dopamine Antagonists

Extrapyramidal symptoms: dyskinesia, tardive dyskinesia
Akathisia
Dystonia

29

Define Dyskinesia

Movement disorders including any of a number of repetitive, involuntary, & purposeless body or facial movements

30

Examples of Dyskinesia

Tongue movements
Lip smacking
Finger movements
Eye blinking
Movements of the arms or legs