Bipolar Disorder - Gen. Principles of Pharmacotx

Question 1

When would a mood stabilizer be used in BD pts?

Answer 1

During manic episodes and to prevent manic and MDD episodes

Question 2

When would an antidepressant be used in BD pts?

Answer 2

During episodes of bipolar depression

Question 3

When would Li be preferred over divalproex?

Answer 3

When pt displays classical, euphoric mania (elated mood without depressive sx’s)

Question 4

When would divalproex be preferred over Li?

Answer 4

When pt has irritable/dysphoric mania

Question 5

What are our first line options for tx’ing acute mania?

Answer 5

Li OR Divalproex OR atypical antipsychotic OR 2-drug combo (Li or DVP + AAP)

Question 6

What do we do if no response is observed in BD pts within 2 weeks of starting a 1st line agent?

Answer 6

Add-on or switch should be considered

Question 7

What add-on tx strats are possible (i.e. 2nd line add-on)?

Answer 7

Olanzapine + Li OR divalproex

Question 8

What switch strats are possible (i.e. 2nd line switch tx)

Answer 8

Olanzapine, carbamazepine, ziprasidone, haloperidol

Question 9

In what specific pop should we be careful using divalproex?

Answer 9

Women of childbearing age

Question 10

Agents not recommended for acute mania?

Answer 10

eslicarbazepine, gabapentin, LAMOTRIGINE, omega 3 fatty acids, topiramate

Question 11

Best agent for mania prevention (i.e. maintenance tx)?

Answer 11

Lithium

Question 12

T or F: Whatever was effective in tx’ing acute mania will probably be effective in the maintenance phase too.

Answer 12

T

Question 13

BDI depression 1st line tx’s

Answer 13

1. quetiapine
2. lurasidone + Li/divalproex
3. Li
4. lamotrigine
5. lurasidone
6. quetiapine + Li (esp. if sleeping probs)

Question 14

BDI - how long before improvement of depressive episode?

Answer 14

usually 2 weeks, but can be up to 2 mths for full improvement

Question 15

BDI - add-on/switch tx’s for BDI depression?

Answer 15

1. quetiapine
2. lurasidone + Li/divalproex
3. Li
4. lamotrigine
5. lurasidone
6. quetiapine + Li (esp. if sleeping probs)

(EXACT SAME AS first-line agents - just pick a diff one)

Question 16

What’s definitely NOT recommended in tx’ing acute bipolar depression?

Answer 16

Antidepressant monotx (mood switching conern)

Question 17

T or F: Maintenance tx for BDI is not necessary after the very first mood episode.

Answer 17

F

Even after the FIRST mood episode, indefinite tx must be started

Question 18

First line maintenance tx’s for BDI

Answer 18

1. Li
2. Quetiapine
3. Divalproex
4. lamotrigine
5. asenapine OR aripiprazole (PO/IM)
6. quetiapine or aripiprazole + Lithium/divalproex

Question 19

First line add-on/switch tx for BDI maintenance?

Answer 19

1. Li
2. Quetiapine
3. Divalproex
4. lamotrigine
5. asenapine OR aripiprazole (PO/IM)
6. quetiapine or aripiprazole + Lithium/divalproex

(EXACT same as first line maintenance tx’s for BDI - just pick a diff 1st line tx)

Question 20

Mixed episodes pharm tx

Answer 20

d/c antideps

monotx: atypical antipsychotic OR combo tx (Li or divalproex + atypical antipsychotic)
- -> This is the same tx for acute manic phase

Question 21

Preferred bipolar agent for pregnant women?

Answer 21

Lamotrigine

Question 22

CI’ed bipolar drugs in preggos?

Answer 22

Carbamazepine and valproic acid

Question 23

What can happen if a pregnant woman takes Li?

Answer 23

Epstein’s anomaly in the baby’s heart (small risk)

Question 24

What drug has the most evidence for preventing suicide?

Answer 24

Li