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Flashcards in Bipolar Pharmacy Deck (35)
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1

Mood swings causes are unknown, although catecholamine-related activity may be present.
1. Drugs that increase this activity tend to _______ mania?
2. Drugs that reduce activity of dopamine or norepinephrine ________ mania?

1. exacerbate

2. relieve

2

Some important observations to make before discussing treatment of psychotic disorders:
1. Two factors must shape treatment…

1.
-How the patient has been affected by the disorder
-How the patient will be helped by the treatment

3

Acute Mania and Hypomania.
Patients presenting with acute mania should be assessed for the following:
7

1. Suicide risk
2. Aggressiveness
3. Risk of violence to others
4. Ability to adhere to a treatment program
5. Substance abuse evaluation and treatment
6. Alcohol, caffeine and nicotine intake

7. Antidepressants should be discontinued

4

Biological Therapies
1. ***Antipsychotic drugs treat what?
-They do not treat what?

2. Classes of Meds? 4

1. the symptoms (They DO NOT cure the disorder)

2. Classes of Medications:
-Lithium (Mood Stabilizer)
-Anticonvulsants (Mood Stabilizer)
-First Generation Antipsychotics
-Second Generation Antipsychotics (Atypical Antipsychotics)

5

Mood stabilizing agents
3

The choice of mood stabilizer is often based on what? 3

1. Lithium
2. Valproate (Depakote)
3. Carbamazepine (Tegretol)

The choice of a mood stabilizer is often based upon:
1. Previous history
2. Side-effect profiles
3. Co-existing medical illness

6

Common side effects of mood stabilizing medications include:

8

1. Drowsiness
2. Dizziness
3. Headache
4. Diarrhea
5. Constipation
6. Heartburn
7. Mood swings
8. Stuffed or runny nose, or other cold-like symptoms

7

LITHIUM
1. Significantly decreases the frequency and severity of what? 2

2. May decrease what turnover? 2

3. Blocks the development of what?

4. May augment the synthesis of of what? By doing what?

5. Use less first line with new what?.

6. May work better in the ___________ phase of therapy.

1. both manic and depressive episodes in about 70% of patients.

2. norepinephrine and dopamine

3. dopamine receptor supersensitivity

4. acetylcholine, by increasing cholamine uptake into nerve terminals

5. atypical antipsychotics

6. maintenance

8

Lithium
Disadvantages?
7

1. Has a low therapeutic index (dont need much to have an effect)
2. Required constant blood level monitoring
3. Renal clearance of lithium is reduced about 25% by diuretics
4. Tremor is a common side effect (how could we counter this?)
5. Decreased thyroid function
6. Polydipsia, polyuria
7. Edema, weight gain

9

Labs to monitor for Lithium? 3

Labs
1. Bun, Creatinine
2. Thyroid functions
3. Lithium levels


10

1. Valproate (Depakote): Drug class?
2. Advanatges? 4

3. SE? 4

4. Labs to monitor? 3

1. Antiepileptic

2.
-Side effect profile less than that of Lithium
-Quick onset
-May increase dose more rapidly (over a few days) to increase therapeutic range
-Larger therapeutic window – 50-125

3. Side effects:
-Weight gain
-N & V
-Hair loss
-Tremor (not as significant as Lithium)

4. Labs
-Liver functions
-Platelets
-Valproate levels

11

Carbamazepine (Tegretol)
1. Drug class?
2. Therapeutic window?
3. SE? 5
4. Labs? 3

1. Anti-seizure
2.
Comparable efficacy to Lithium
---therapeutic window is 3-14

3. Side effects
-N & V
-Hyponatremia
-Rash (Sevens Johnsons and TENS)****
-Drowsiness, blurred vision
-Blood dyscrasia’s

4. Labs
-Liver functions
-CBC, Serum NA
-Carbamazepine levels

12

1. Lamotrigine (Lamictal) drug class?
2. Treats bipolar depression without triggering what? 4
3. It has not demonstrated efficacy in the treatment of what?
4. Lamotrigine can be used as a first-line treatment what? 2

1. Anti-epileptic
2. Treats bipolar depression without triggering
-mania,
-hypomania,
-mixed states, or
-rapid cycling.

3. It has not demonstrated efficacy in the treatment of acute mania.

4. Lamotrigine can be used as a first-line treatment for
-acute depression in bipolar disorder as
-well as a maintenance therapy.

13

Mood stabilizing agents
1. According to the APA recommendations:
1st line pharm therapy for patients with ACUTE severe manic or mixed episodes is what? 2

2. For less severe, what? 3

3. __________ as a first-line treatment for acute depression in bipolar disorder as well as a maintenance therapy, but not recommended for treatment of ACUTE mania.

1.
-an antipsychotic agent
-combined with either Lithium or Valproate.


2. monotherapy with either Lithium, Valproate or an antipsychotic agent.

3. Lamotrigine

14

First Generation Antipsychotics
DOPAMINE ANTAGONISTS
2

Effective in treatment of what?

1. Haloperidol (Haldol)
2. Chlorpromazine (Thorazine)


Effective in the treatment of schizophrenia, especially the positive symptoms (e.g. hallucinations, delusions)

15

First Generation Antipsychotics
DOPAMINE ANTAGONISTS two major shortcomings?

Two major shortcomings:
1. Only a small percentage of patients (around 25%) are helped enough to recover a reasonable amount of normal mental functioning
2. Associated with both annoying and serious adverse effects

16

First Generation Antipsychotics
DOPAMINE ANTAGONISTS
Adverse effects
Some of the more common annoying effects are what? 2

Potenital serious effects? 2


1. akathisia (subjective feeling of muscular tension which can cause restlessness, pacing, repeated sitting or standing) and
2. parkinsonian-like rigidity and tremor

Potential serious effects include 1. tardive dyskinesia and
2. neuroleptic malignant syndrome

17

First Generation Antipsychotics DOPAMINE ANTAGONISTS: SE.

Extrapyramidal symptoms 2

1. Dyskinesia
2. Tardive dyskinesia
3. Akathisia
4. Dystonia

18

1. What is dyskinesia?


2. These movements can include? 5

Dyskinesia - movement disorders including any of a number of repetitive, involuntary, and purposeless body or facial movements.

2.
-Tongue movements, such as "tongue thrusts" or "fly-catching" movements
-Lip smacking
-Finger movements
-Eye blinking
-Movements of the arms or legs.

19

Tardive dyskinesia can occur when?

occurs after long-term treatment with an antipsychotic medication.
Sometimes, this condition may become permanent.

20

1. What is akathisia? 3symtpoms

2. Can be at risk for?

1.
-an extreme form of internal or external restlessness.
-A complete inability to sit still, with an undeniable urge to be moving constantly.
-An entirely inner feeling of jitteriness or shakiness.

2. Can be exhausting and lead to suicide ideations

21

1. Dystonia is what?

a muscle tension disorder involving very strong muscle contractions.
These uncontrollable muscle contractions can cause unusual twisting of parts of the body, especially the neck

22

1. Extrapyramidal tracts are chiefly found in the reticular formation of the what and what,
2. and target neurons in the spinal cord involved in what? 4

3. These tracts are in turn modulated by various parts of the central nervous system, including the what? 5

1. pons and medulla

2.
-reflexes,
-locomotion,
-complex movements, and
-postural control

3.
-nigrostriatal pathway,
-the basal ganglila,
-the cerebellum,
-the vestibular nuclei, and
-different sensory areas of the cerebral cortex.

23

First Generation Antipsychotics DOPAMINE ANTAGONISTS
1. These extrapyrmidal side effects can happen with atypical antipsychotics, but the likelihood is much less than with drugs like what? 2

2. Is there anything to help?

1. Haldol and Thorazine.

2. Cogentin

24

1. What is Cogentin?
2. MOA?

1. an anticholinergic medication
2. blocks the effects of the neurotransmitter acetylcholine.

25

By blocking the effects of acetylcholine, Cogentin helps to re-establish a normal balance between what?

dopamine and acetylcholine.

26

SEROTONIN-DOPAMINE ANTAGONISTS (SDAS)
ATYPICAL ANTIPSYCHOTICS
Second Generation Antipsychotics
1. Referred to as what?
2. Interact with different subtypes of what compared to standard antipsychotics?
3. Fewer what? 3
4. Effective for what symtpoms?
5. Effective for who?
6. It is suggested that antipsychotics may be slightly more effective than _______________ as monotherapy for acute mania, and may also be used as adjunctive therapy with mood stabilizers?

1. Referred to as “atypical antipsychotics”

2. dopamine receptors than standard antipsychotics

3.
-Produce fewer neurological and
-endocrine side effects
-Cause very few, if any, extrapyramidal side effects

4. Effective in treating negative symptoms (such as withdrawal) in addition to the positive symptoms.

5. Effective for a broader range of patients

6. mood stabilizers

27

SEROTONIN-DOPAMINE ANTAGONISTS (SDAS)
ATYPICAL ANTIPSYCHOTICS
Second Generation Antipsychotics
1. SE? 4
2. Labs and other tests? 4

1. Side effects:
-Weight gain
-Glucose intolerance
-Diabetes mellitus
-Hyperlipidema

2. Labs and other
-Serum glucose
-Lipids
-Weight
-Waist circumference

28

SEROTONIN-DOPAMINE ANTAGONISTS (SDAS)
ATYPICAL ANTIPSYCHOTICS Second Generation Antipsychotics
Other Side Effects?
7

1. Drowsiness
2. Dizziness when changing positions
3. Blurred vision
4. Rapid heartbeat
5. Sensitivity to the sun
6. Skin rashes
7. Menstrual problems for women

29

SEROTONIN-DOPAMINE ANTAGONISTS (SDAS)
ATYPICAL ANTIPSYCHOTICS
6

1. Quetiapine (Seroquel)
2. Olanzapine (Zyprexa)
3. Risperidone (Risperdal)
4. Clozapine (Clozaril)
5. Ziprasidone (Geodon)
6. Aripiprazole (Abilify)

30

Quetiapine (Seroquel)
1. Main SE?

2. Olanzapine (Zyprexa)
Main SE??

1. Drowsiness

2. Weight gain most pronounced