Flashcards in Somatic Therapies III Deck (57):
What are the two drugs approved for bipolar maintenance?
What are the three drugs that are helpful for the depressive stage of bipolar disorder?
What is the onset of action of Li?
What organ metabolizes Li?
What is the WBC abnormality that can occur with Li use?
Demarginalization causing leukocytosis
True or false: Li is rapidly absorbed
What are the pharmacokinetics of Li?
What are the side effects of Li?
How often should Li levels be checked?
Monthly for 3 months, then q 3 months
What are the drugs that increase Li levels?
Na depleting diuretics
Where is Li reabsorbed in the kidney?
Long term use of Li can increase what lyte level?
What are the cognitive side effects of Li?
What are the congenital effects of Li?
Ebstein cardiac anomaly
When does Li toxicity come into play?
1.5 levels and above
What is the treatment for Li toxicity?
When is divalproex used for bipolar?
What is the MOA of divalproex?
Increase GABA by inhibiting degradation and stimulating synthesis
What organ metabolizes divalproex? What are the labs that are monitored?
What are the teratogenic effects of divalproex?
What are the side effects of divalproex?
What are the effects of divalproex in prego?
What is the MOA and use of carbamazepine?
-Acute mania and bipolar
-Na channel blocker and GABA agonist
What is the major side effect of carbamazepine?
What is the MOA and use of lamotrigine?
-Na channel blocker
What is the major side effect of lamotrigine? What must be done to prevent this?
-Start slow and titrate up
What is the role of topiramate and gabapentin in the treatment of bipolar disorder?
No evidence of efficacy
What are the three major first line drugs in the treatment of Bipolar disorder?
What is the role of SGAs in the treatment of bipolar disorder?
What is considered an adequate trial of Li, valproate, or lamotrigine?
What is the second line treatment for Bipolar?
Anticonvulsant + Li
SGAs + Li
True or false: most Bipolar DOs need only one drug
What is the role of ECT for bipolar disorder?
How hard to treat is depression with bipolar disorder, relative to MDD? Mania?
Depression is Much harder, but mania relatively easy
What is the difference between bipolar I and II?
I = classic
II = hypomania
If you have a pt with refractory depression, what should always be suspected?
True or false: most of the time, bipolar patients are either euthymic, or depressed, but rarely manic
What is the thinking of the MOA of ECT?
What has the highest success rate for depression?
What are the three major indications for ECT?
-Severe suicidal ideation
-Depression + refusal to eat/drink
How many treatments are needed for ECT?
6-12 weeks, with 3 treatments per week
What is the role of atropine in ECT?
What are the adverse effects of ECT?
-Fractures d/t muscle relaxant
What is the effect of ECT on anterograde memory?
Minimal evidence that it affects it
What are the two meds for ADHD?
What is the MOA of clonidine?
What are the side effects of stimulants?
What are the CV effects of stimulants?
What are the usual hallucinations with stimulant use?
Feeling bugs on their skin
What is the general MOA of stimulants?
-Blockade of NE and dopamine reuptake
What is the major problem with stimulants use and ADHD?
Physicians keep increasing the dose to treat multiple, comorbid ADHD issues
When are stimulants used in depression?
Treat persistent anergia or amotivation
Is it ethical to prescribe stimulants for neuroenhancement?
Yes, but insurance will not cover it
What is the MOA and use of atomoxetine? Risks/benefits?
NE reuptake inhibitor to treat ADHD--lower side effects, longer effect but less efficacious
True or false: age and weight are good predictors for dosing stimulants
What is the MOA of guanfacine?