Card Set Information
Biopolar and Affective Disorders
Define Biopolar -1
manic disorder(s) or mixed episode(s) plus major depressive episode
major depressive(s) episode(s) plus hypomanic episode(s): never presenting with a full manic or mixed episode.
recurring hypomanic symptoms plus depressive symptoms: episodes are insufficient to meet DMS-4 criteria for major depressive and manic symptoms
What percentage of the population is affected by bipolar?
What does an onset of a first manie epised after the age of 40 indicate?
substance abuse or other g eneral medical condition
is bilopar recurrent?
yes, in >90% of cases
What differential diagnosises do you need to rule out before diagnosising Bipolar?
enodcrine or metabolic disorders, hyperthyroidism, infections(encephalitis), temporal lobe epilespy, medications (alcohol, steroids, xanthines) and sleep deprivation
Hospitalization needed for major depressive episode?
Do manic episodes need to be hospitalized?
Do hypomatic episodes need to be hospitalized?
When starting a new medication, how often should you be seen?
Every two weeks
How often should severely ill patients be seen?
weekly, instead to every two weeks for lesser ill patients
How often should a stable patient be seen?
every month for the first 3 months then every 2 to 3 months
Reasons for non-adherence to meds?
side effects (tremor, thrist, frequent urination, sedation, obesity, froggy feeling), missed the highs, dislike the though of mood control by meds, felt well while on a manic high, denial
Name some mood stabilizers
Lithium, valproic acid, carbamazepine, gabapentin, lamotrigine, topiramate, oxcarbamazepine
Drugs to treat classic mania/mixed mania
lithium, valproic acid, carbamazepine, oxcarbamazepine, SGAPs
Drugs to treat depression as a subtype of bipolar disorder
lamotrigine, lithium, quetiapine
Drugs to treat rapid cycling
valproic acid, lamotrigine, SGAPs
Drugs to treat Bipolar-1
Maintenace drugs for bipolar disorder
Lithium, Lamotrigine, SGAPs
Is Lithium effective in unipolar depression?
How effective is Lithium in aborting manic/hypomanic episodes?
60-80% typically, may take about 7 days
Name some pre-lithium work-up labs
CBC, electrolytes, renal function, TFT, urinalysis, ECG, BHCG
Serum concentation for acute mania of lithium dosing
Serum concentration for maintenance of lithium dosing
Benefit of QDay dosing of Lithium
minimize potential renal damage
Dosing of Lithium
: 600-900 mg/d
: 900-2400 mg/d
Name the drug to initiate to reduce muscle weakness or tremor
Propranolol, or you can reduce the dose of Lithium
What is an option for CNS toxicity such as confusion or agitation with Lithium?
What is an option for GI distress with Lithium?
reduce dose or switch to ER form
How would you reduce the SE of polyuria/polydispia related to Lithium?
reduce dose, manage intake, dose hs
Diabetes insipidus-like syndrome can be seen in patients with large fluid intake who are taking Lithium. How would you treat this SE?
Manage fluid and use HCTZ or amiloride
Hypothyroidism can be a non-dose related SE of Lithium. How would you treat this?
D/C lithium or administer levothyroxine
Would you D/C lithium if the patient developed a rash?
No, treat symptomatically
How do ACE and ARBS interact with Lithium?
They increase Li concentrations
Can a patient take NSAIDs while on Li?
Avoid, can increase Li concentrations
Are diuretics C/I with Lithium?
diuretics-thiazides increase Li concentrations by 40-50%. Furosemide and amiloride have little effect
1.5-2.0 mEq/L is what level of Li toxicity?
Mild- drowsiness, poor concentration, unsteady gait, hand tremors and diarrhea
2.0-3.0 mEq/L is what level of Li toxicity?
moderate- speech difficulties, muscle weakness, confusion, sedation, and possible death
Concentrations of >3.0 mEq/L are what level of Li toxicity?
severe- convulsions, increased deep tendon reflexes, CV collapse, death
How often do you monitor Li levels?
weekly for first month until stable, then monthly for three months, then every six months
Valproic acid is considered first line for...?
rapid cyclers and patients with dysphoric mood
When should you use a delayed-release valproic acid?
To minimize GI side effects
Do valproic capsules or EC tablets absorb faster?
Monitoring and target level for valproic acid?
monitor levels between
: 50-125 mcg/ml
: 75 mcg/ml
Loading dose needed for valproic acid?
yes (hint- add a zero to a patient weight in lbs)
Name some SE of valproic acid
Hepatotoxicity (rare- monitor LFTs) a concern for children
hyperammonemia (rare) tx with L-carnitine
C/I in pregnancy
Usual dose range for Carbamazepine?
initially 200 mg bid
increase every 3-4 days to a range of 600-1600 mg/day in divided doses
Name some SE of carbamazepine
ataxia, dizziness, ha, blurred vision, hyponatremia, dry mouth, constipation, rash, hematological effects
Lamotrigine is indicated for...?
tx of bipolar-1
How does CBZ, phenytoin and phenobarbital affect lamotrigine?
decreased 1/2 life to about 15 hours
How does birth control affect lamotrigine?
decreases lamotrigine concentrations by as much as 50%
Name some SGAPs
What is risperdone used for?
monotherapy or combo with VPA or Li tx of acute mania or mixed episodes of Bipolar Disorder
What is ziprasidone indicated for?
acute mania and mixed episodes with/without psychosis
Olanzapine indicated for?
acute mania and maintenance monotherapy and in comb tx
Quetiapine indicated for?
short term treatment of acute manic episodes associated with BP-1 as monotherapy or adjunct to li or vpa
Clozapine indicated for?
tx of refractory mania as monotherapy or as an add-on to therapy (not FDA approved tho)
Aripiprazole indicated for?
tx of actue bipolar mania including manic and mixed episodes assocated with BP disorder and maintenace