Flashcards in Somatic Therapies III Deck (57):
1
What are the two drugs approved for bipolar maintenance?
-Li
-Lamotrigine
2
What are the three drugs that are helpful for the depressive stage of bipolar disorder?
-Olanzapine
-Quetiapine
-Lurasidone
3
What is the onset of action of Li?
5-7 days
4
What organ metabolizes Li?
Renal
5
What is the WBC abnormality that can occur with Li use?
Demarginalization causing leukocytosis
6
True or false: Li is rapidly absorbed
True
7
What are the pharmacokinetics of Li?
Linear
8
What are the side effects of Li?
-Polyuria/polydipsia
-Acne
-Hypothyroidism
9
How often should Li levels be checked?
Monthly for 3 months, then q 3 months
10
What are the drugs that increase Li levels?
Na depleting diuretics
11
Where is Li reabsorbed in the kidney?
Proximal tubule
12
Long term use of Li can increase what lyte level?
Ca
13
What are the cognitive side effects of Li?
-Distractibility
-poor memory
-Confusion
14
What are the congenital effects of Li?
Ebstein cardiac anomaly
15
When does Li toxicity come into play?
1.5 levels and above
16
What is the treatment for Li toxicity?
Dialysis
17
When is divalproex used for bipolar?
Rapid cyclers
18
What is the MOA of divalproex?
Increase GABA by inhibiting degradation and stimulating synthesis
19
What organ metabolizes divalproex? What are the labs that are monitored?
-Hepatic
-LFTs, CBC
20
What are the teratogenic effects of divalproex?
NTDs
21
What are the side effects of divalproex?
-Toxic hepatitis
-Hair loss
-PCOS
22
What are the effects of divalproex in prego?
NTDs
23
What is the MOA and use of carbamazepine?
-Acute mania and bipolar
-Na channel blocker and GABA agonist
24
What is the major side effect of carbamazepine?
Aplastic anemia
25
What is the MOA and use of lamotrigine?
-Na channel blocker
-Seizures
26
What is the major side effect of lamotrigine? What must be done to prevent this?
-Steven-Johnson syndrome
-Start slow and titrate up
27
What is the role of topiramate and gabapentin in the treatment of bipolar disorder?
No evidence of efficacy
28
What are the three major first line drugs in the treatment of Bipolar disorder?
Li
Valproate
Lamotrigine
29
What is the role of SGAs in the treatment of bipolar disorder?
second line
30
What is considered an adequate trial of Li, valproate, or lamotrigine?
3-4 weeks
31
What is the second line treatment for Bipolar?
Anticonvulsant + Li
or
SGAs + Li
32
True or false: most Bipolar DOs need only one drug
False--need 2+
33
What is the role of ECT for bipolar disorder?
Refractory dz
34
How hard to treat is depression with bipolar disorder, relative to MDD? Mania?
Depression is Much harder, but mania relatively easy
35
What is the difference between bipolar I and II?
I = classic
II = hypomania
36
If you have a pt with refractory depression, what should always be suspected?
Bipolar
37
True or false: most of the time, bipolar patients are either euthymic, or depressed, but rarely manic
True
38
What is the thinking of the MOA of ECT?
downregulate beta-receptors
39
What has the highest success rate for depression?
ECT
40
What are the three major indications for ECT?
-Refractory depression
-Severe suicidal ideation
-Depression + refusal to eat/drink
41
How many treatments are needed for ECT?
6-12 weeks, with 3 treatments per week
42
What is the role of atropine in ECT?
-Prevent bradyarrhythmias
-Reduce secretions
43
What are the adverse effects of ECT?
-Fractures d/t muscle relaxant
-Postictal confusion
-Memory impairment
44
What is the effect of ECT on anterograde memory?
Minimal evidence that it affects it
45
What are the two meds for ADHD?
-Methylphenidate (ritalin)
-Dextroamphetamine (adderall)
46
What is the MOA of clonidine?
Alpha-2 agonism
47
What are the side effects of stimulants?
-Anorexia
-Emotional lability
-Tics
48
What are the CV effects of stimulants?
-Increased HR
-Sudden death
49
What are the usual hallucinations with stimulant use?
Feeling bugs on their skin
50
What is the general MOA of stimulants?
-Blockade of NE and dopamine reuptake
51
What is the major problem with stimulants use and ADHD?
Physicians keep increasing the dose to treat multiple, comorbid ADHD issues
52
When are stimulants used in depression?
Treat persistent anergia or amotivation
53
Is it ethical to prescribe stimulants for neuroenhancement?
Yes, but insurance will not cover it
54
What is the MOA and use of atomoxetine? Risks/benefits?
NE reuptake inhibitor to treat ADHD--lower side effects, longer effect but less efficacious
55
True or false: age and weight are good predictors for dosing stimulants
False
56
What is the MOA of guanfacine?
Alpha-2 agonist
57