Shared Flashcard Set


CNS: Bipolar
Medications & Diagnosis criteria indicated for treatment of these disorders.

Additional Pharmacology Flashcards




Lithium (g)
(b)Eskalith, Eskalith CR, Lithobid, Lithium citrate

Must wait 5 days to check trough

Acute mania: 1-1.2mEq/L
Serum Levels:
Acute Depression: 0.8-1mEq/L
Maintenance: 0.6-0.8mEq/L
TOXIC: > or = 1.5mEq/L

Renal Excreted

NVD, weight gain, tremor, sedation, thirst
Avoids SEs: Take with food, divide doses, switch to ER

Interactions: NSAIDS (use APAP and aspirin for pain), Caffeine

Monitoring: EKG, Thyroid Fxn, Renal Fxn, CBC w/ diff, urinalysis, pregnancy test

Counseling: Avoid sleep deprivation, drug levels are important, GI upset=take with food
Divalproex (g)
(b)Depakote, Depakote Sprinkle Caps, Depakote ER, Depakene

Serum conc. correlate with antielleptic effect, NOT antimanic effect

Must wait 3 days to check trough

SEs: asthenia,dizziness, GI, somnolence, thrombocytopenia (DOSE RELATED)

BLACK BOX WARNING: Hepatotoxicity, Teratogenicity, Pancreatitis

Interactions: Lamotrigine (Divalproex increases lamotrigine by 100mg= Dogs increase love)--> decrease dose of lamotrigene by 100mg if giving together

Monitors: Pregnancy, Liver Fxn, Renal Fxn, CBC w/diff
Carbamazepine (g)
(b)Carbatrol, Equatro, Tegretol, Tegretol XR

Therapeutic conc. correlate with antiepileptic effect NOT antimanic effect

Must wait 4 days to get trough

Met: CYP3A4 Autoinducer (t1/2 decreases overtime)
induces CYP1A2, CYP2C9, CYP2C19

SEs: Dizziness, drowsiness, NV, unstediness

BLACK BOX WARNING: Toxic Epidermal Necrolysis (TEN) & Steven Johnson's Syndrome (SJS), Aplastic Anemia & Agranulocytosis

Interactions: 3A4 inhibitors (grapefruit, clarithromycin, diltiazem), 3A4 inducers (Phenytoin, Phenobarbital, Rifampin)

CBZ decreases other drugs: Lamotrigine (inc. Lamotrigine dose by 400mg with given together), Oral contraceptives, Protease inhibitors

Monitoring: Preg, Liver Fxn, Electrolytes, CBC w/diff
Oxcarbazepine (g)
(b) Trileptal

Structurally similar to Carbamazepine; 3rd option

SEs: dizziness, nausea, rash, headache

Warnings: Hyponatremia, TEN & SJS, suicidal ideation, rare agraulocytosis and aplastic anemia

Interactions: OXC induces CYP3A4/5 (decreases oral contraceptives)

Monitoring: Electrolytes, Pregnancy
Lamotrigine (g)
(b) Lamictal, Lamictal CD, Lamictal ODT, Lamictal starter kits

SEs: dizziness, fatigue, headache, insomnia, nausea, rash

BLACK BOX WARNING: SJS & TEN (must follow recommended dose titration)

Interactions: Lamotrigine decreases levonorgestrel and oral contraceptives decrease lamotrigine

Monitoring: LFTS, Renal Fxn, Pregnancy
DSM5 Criteria for Manic Episode
Elevated, expansive, or irritable mood and persistenly increased goal-directed activity or energy lasting > or = to 1 week.

> or = to 3 symptoms if elevated/expansive, or 4 if irritable
-Infalted Self-Esteem
-Goal directed activity
-Flight of ideas
-Activities with painful consequences
-Sleep need is decreased

**If symptoms are severe enough for hospitalization, DO NOT have to display symptoms for 1 week**

> or= 1 manic episode is required to receive BPAD1 Dx
DSM5 Criteria for Depressed Episode
> or = 5 symptoms for at least 2 weeks. (At least 1 symptom MUST be anhedonia or depressed mood)
-Suicidal ideation
-Interest lost (anhedonia)
-Energy loss
-Depressed modd
-Concentration impairment
-Appetite changes
-Psychomotor changes
-Sleep changes
DSM5 Criteria for Bipolar II Disorder
Criteria has been met for
> or = 1 hypomanic
> or = 1 depressive episode

Hypomanic episode
-Elevated, expansive or irritable mood lasting 4-7 days
-Need 3 symptoms of mania or 4 if irritable
-If psychosis is present, they automatically qualify as having manic episode regardless of time
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