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PT2 Psych 7-12 > bipolar pharmacology > Flashcards

Flashcards in bipolar pharmacology Deck (35)
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1
Q

mania

A

period of elevated or irritable mood and increased energy and activity lasting for at least 1 week

2
Q

symptoms of mania

A

at least 3 of the following

  • inflanted self-esteem or grandiosity
  • decreased need for sleep
  • great talkativeness or pressure speeche
  • flight of ideas or racing thoughts
  • decreased attention span
  • increase in goal directed activity
  • poor impulse control
3
Q

hypomania

A
  • mood elevation with optimism, not grandiosity
  • hypersexuality
  • have increased energy, feel good, and are more productive
4
Q

triggers of manic and hypomanic states

A

changes in activity, appetite, sleep, and sometimes anxiety

5
Q

initial mood episodes of bipolar tend to be

A

depressive in younger patients, often mistaking it for depression

6
Q

mixed episodes

A
  • depressive and manic features occurring concurrently nearly every day
  • suicide attempts and substance abuse are increased in likelihood
7
Q

most common symptom of bipolar disorder

A

depression

8
Q

what happens in the course of bipolar disorder if left untreated

A

inter-episode intervals with gradually become shorter

9
Q

initial manic/hypomanic episode is trigger by

A

major acute stressor or sleep deprivation

10
Q

Bipolar I

A

at least one episode of mania or mixed depressive/manic symptoms

11
Q

Bipolar II

A

at least one major depressive episode and one hypomanic episode

12
Q

cyclothymic disorder

A

hypomanic and depressive symptoms that don’t meet criteria for hypomania or MDD that last for at least 2 years

13
Q

epidemiology of bipolar disorder

A
  • about 1% prevalence of each type
  • men/women equally likely
  • geographic distribution is similar
  • ethinic distribution has asians with lower rate
14
Q

suicide rate in bipolar patients

A

10-20 times higher than in general population

15
Q

main risk factors for bipolar

A
  • urban areas
  • institutionalized and homeless
  • single has greater risk than married
  • Fx of bipolar, schizophrenia, substance abuse
16
Q

what percentage of bipolar risk is genetic

A

75-85%

17
Q

genes implicated in bipolar disorder

A

BDNF
CLOCK genes
GSK-3beta

18
Q

most well known neurobiology changes in bipolar

A

hypofunction of prefrontal cortex and amygdala

19
Q

shift between mania and depression is caused by

A
  • instability of the electric properties of neurons, likely facilitated by oxidative stress and neuroinflammatory processes
  • changes in activity of dopaminergic system
20
Q

mania neurobiology is associated with

A

hyperactivity of dopamine neurotransmission

21
Q

depression neurobiology is associated with

A

dopaminergic hypoactivity

22
Q

mood stabilizers for bipolar therapy

A
  • lithium
  • valproic acid
  • carbamazepine
  • lamotrigine
23
Q

lithium therapeutic index

A

very narrow

24
Q

lithium toxicity level

A

over 1.5 mmol/L

25
Q

lithium MoA

A
  • may inhibit release of monoamines and ACh from nerve endings AND increase their uptake
  • interferes with inositol trisphosphate formation
26
Q

IP3 is synthesized by

A

phospholipase C

27
Q

enzymes inhibited by lithium

A

IPP
ImpA
GSK-3beta
all 3 help recycle inositol

28
Q

time it takes to reach therapeutic levels of lithium

A

about 2 weeks

29
Q

recommended dose of lithium for acute mania

A

1800 mg/day in 2-3 daily doses during meals

30
Q

desired serum level of lithium

A

1-1.5 mmol?L

31
Q

lithium side effects

A
  • neurological effects
  • ophthalmic
  • otic
  • psychosis
  • CV (arrhythmias)
  • endocrine (hypothyroidism)
  • GI
  • renal
  • autoimmune disease risk
  • hematologic
  • dermatologic
32
Q

signs of lithium overdose

A
  • persistent diarrhea
  • vomiting/ severe nausea
  • coarse trembling of hands or legs
  • swelling in feet or lower legs
33
Q

treatment for lithium toxicity

A
  • gastric lavage
  • activated charcoal
  • IV NS if hypotensive
34
Q

contraindications of lithium

A
  • renal disease
  • CV disease
  • Na depletion/dehydration
  • pregnancy and lactation
35
Q

lithium drug interactions

A
  • SSRI
  • diuretics
  • NSAIDs
  • ACE inhibitors
  • CCB
  • metronidazole