Flashcards in Bipolar Pharm Deck (43)
What medications can trigger mania?
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
What should patients be assessed for when presenting with mania?
Risk of violence to others
Ability to adhere to treatment program
Substance abuse evaluation & treatment
Alcohol, caffeine, & nicotine intake
What should be discontinued when a patient presents with mania?
Classes of Medications
Mood Stabilizers: lithium, anticonvulsants
First generation antipsychotics
Second generation antipsychotics
Mood Stabilizing Agents
What is important in determining which mood stabilizer to use?
Co-existing medical illness
Mood Stabilizing Agent SE
Other cold-like symptoms
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
Low therapeutic index
Constant blood level monitoring
Renal clearance reduced by diuretics
Tremor common SE
Decreased thyroid function
Edema, weight gain
Labs to Monitor Lithium
Thyroid function tests
Why Valproate (Depakote)
SE profile less than lithium
Increase dose more rapidly
Larger therapeutic window
What drug class is valproate (Depakote) in?
SE of Valproate (Depakote)
Labs for Monitoring Valproate (Depakote)
What drug class is carbamazepine (Tegretol) in?
SE of Carbamazepine (Tegretol)
Rash (SJS & TENS)
Labs to Monitor with Carbamazepine (Tegretol)
Liver function tests
What drug class is lamotrigine (Lamictal)
What does lamotrigine (Lamictal) treat?
Bipolar depression without triggering mania, hypomania, mixed states, or rapid cycling
What medication is not recommended for treatment of acute mania
Medications to use in acute severe manic or mixed episodes
Lithium or Valproate
Medications to use in acute moderate manic or mixed episode
Examples of First Generation Antipsychotics
Shortcomings of FGAs
Small percentage of patients helped to recover
Annoying & serious AE
AE of FGAs
Parkinsonian-like rigidity & tremor
Neuroleptic malignant syndrome
Subjective feeling of muscular tension which can cause restlessness, pacing, repeated sitting or standing
SE of FGA Dopamine Antagonists
Extrapyramidal symptoms: dyskinesia, tardive dyskinesia
Movement disorders including any of a number of repetitive, involuntary, & purposeless body or facial movements