Bipolar Drugs Flashcards Preview

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Flashcards in Bipolar Drugs Deck (29)
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1
Q

What drugs should not be used as sole treatment in bipolar disorder?

A

Antidepressants - can lead to manic episode

2
Q

What is a unique benefit of lithium?

A

It reduces the risk of suicide in patients

3
Q

What happens to Li+ levels with diuretics that act at the proximal tubule?

A

Li+ will decrease

4
Q

What happens to Li+ levels with diuretics that act at the distal tubule?

A

Li+ will increase

5
Q

For what kind of diuretics will the Li+ level remain normal?

A

Loop Diuretics

6
Q

What does Na+ depletion do the Li+ level?

A

Increases it

7
Q

Lithium SE

A
  • Decreased thyroid function
  • Increased parathyroid function
  • Tremor
  • Decreased concentration
  • Sedation
  • Weight gain - VERY slow
8
Q

What is the therapeutic range of Li+ like?

A

Very narrow

9
Q

What is the first line treatment for bipolar disorder?

A

Lithium

10
Q

What are some of the difficulties with taking valproic acid?

A

High amount of GI side effects of diarrhea and nausea.

11
Q

What is the difference between Depakote and valproic acid?

A

Depakote is a mix of valproic acid and sodium valproate that has less GI SE than valproic acid.

12
Q

Depakote is highly _________ in the plasma.

A

Protein-bound

13
Q

What hepatic enzymes does Depakote inhibit?

A

Phase II Glucoronidation - NOT CYP450

14
Q

Depakote SE

A
  • GI problems
  • Tremor
  • Sedation
  • Weight gain
  • Thrombocytopenia @ high doses
  • Increased NH3
15
Q

How does carbamazepine have DDIs?

A

Via the CYP450 system

16
Q

Carbamazepine SE

A
  • Nausea
  • Dizziness
  • Sedation
  • Weight gain
  • Ataxia
  • Stevens Johnson Syndrome
17
Q

Lamotrigine SE

A
  • Benign rash
  • Stevens Johnson Syndrome
  • Nausea
18
Q

When are 2nd Gen anti-psychotics typically used/

A
  • Sever bipolar with psychosis

- Patient is a danger

19
Q

What bipolar disorder drug has the greatest risk of serious birth defects?

A

Depakote

20
Q

What bipolar drug increases the risk of neural tube defects?

A

Carbamazepine

21
Q

Lithium MOA

A

Unknown…

o Inositol recycling: Li+ inhibits a number of enzymes involved in inositol recycling

o Protein kinase C: Li+ may affect specific isozymes of protein kinase C

22
Q

What is the excretion of Li+?

A

Almost exclusively renal

23
Q

What is the effect of spironolactone/amiloride on Li+ levels?

A

Increases Li+ levels

24
Q

Valproic Acid/Depakote MOA

A

Unknown

GABA reuptake inhibitor; may increase GABA in synapse or mimic its affects at postsynaptic
receptors.

25
Q

Carbamazepine MOA

A
  • reduces Na+ influx and depresses synaptic transmission

- reduces release of norepinephrine and excitatory amino acids such as glutamate

26
Q

What drug is not useful for treating a manic episode?

A

Lamotrigine

27
Q

Lamotrigine MOA

A

Unknown

Inhibits release of glutamate

28
Q

What drug can double lamotrigine’s plasma levels?

A

Valproic Acid

29
Q

What bipolar drug is associated with Epstein’s anomaly as a birth defect?

A

Li+

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