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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

What are the contraindications for ECT?

-Heart issues
-Increased ICP or space occupying brain lesion