Term
how mnay weeks of elevated mood do you need for diagnosis of manic depression
what about how mnay other symtpoms do you have to have as well? |
|
Definition
>1 week (can be irritable)
if irritable-4, otherwise 3 |
|
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Term
| what are the symptoms needed for manic depression-4 |
|
Definition
increased talking
poor attention
gradniosity
activities that are pleasurable but super dangerous |
|
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Term
| manic episdoes are described as what 2 things |
|
Definition
-impair normal function
or
hopsitalized due to psychotic symptoms (halluncinations, etc) |
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|
Term
what is the definiton of hypomania
how long do you have to have symtpoms for? |
|
Definition
BD but dont impair daily fucntoin/hospitalization
4 days |
|
|
Term
| bipolar type 1 is defined as |
|
Definition
| manic episdoes + or - major depression |
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|
Term
| bipolar type 2 is definedd as |
|
Definition
| major depresison + hypomania |
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|
Term
| medical conditions that can induce mania-6 |
|
Definition
hyperthyoid
neurosyphallis
post-stroke
cushings
AIDS
epilepsy |
|
|
Term
what are some meds that can induce mania?
(look at the chart right before test)-4 |
|
Definition
alcohol
clonidine
beta 2 agonists
caffiene
thyroid supplment |
|
|
Term
| what are the moodstabilzers-3 |
|
Definition
valproate
cabamezapine
lithium |
|
|
Term
what are the pahrmcotherpay options for BD
which is more for the depression than mania? |
|
Definition
mood stabilizer
lamotrigine
antidepressants
antypical antipsychotics
-lamotrigine and depressants |
|
|
Term
| for combination 1st line, what are the two agents you choose from to use always |
|
Definition
|
|
Term
for cmobination therapy 1st line what are the meds you can choose from to add to the first agent-5
what type of class are these? |
|
Definition
risperidone
quetapine
loanzapine
aripiprazole
asenapine
atypical antischotics |
|
|
Term
| what are the 9 first line monetherapies for BD for mania |
|
Definition
lithium
divalproex
olanzapine
risperidone
quetapine
aripriprazole
ziprasidone
asenapine
paliperidone |
|
|
Term
what are the 2nd line montherapy choices for mania-3
-which should only be used for short term acute, not maintenance? |
|
Definition
ECT
carbamezapine
haloperidol;
haloperidol |
|
|
Term
| what is the secodn line combinaiton therapy for mania |
|
Definition
|
|
Term
| when do you go to secodn line therapies? |
|
Definition
| after a lot of frist lines not working |
|
|
Term
| what monotherapies are not reccomended for mania-4 |
|
Definition
gabapentin
topiramate
lamotrigine
tiagabine |
|
|
Term
| what combinaiton therapies are not reccomended for mania-2 |
|
Definition
risperidone + carbamezapine
olanzapine + cabrbamezapine |
|
|
Term
| what is frist line therapy fro depression monotherapy: -3 |
|
Definition
lithium
lamotrigine
quetapine |
|
|
Term
| what is first lien for combination for depression-4 |
|
Definition
lithium/divalproex + SSRI
olanzapine + SSRI
lithium + divalproex
lithium/divalproex + bupropion |
|
|
Term
| what are the secodn line options for depression , monotherapy-2 |
|
Definition
|
|
Term
| what are the second line therapies for depression, combinaiton |
|
Definition
| quetapine + SSRI, lithium/divalproex + lamotrigine, lithium/divalproex + lurasidone |
|
|
Term
| what monotherapy isnt reccomended for depresison |
|
Definition
| gabapentin, aripirprazole, ziprasdione |
|
|
Term
| what combo therapies arent recocmended for depressoin |
|
Definition
| adjuctive ziprasidone, adjunctive levetiracetam |
|
|
Term
| lithium therapeutic range for maintenance - |
|
Definition
|
|
Term
| lithium theraeutic range fro acute mania |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Li carbonate 450 mg CR tablet |
|
|
Term
|
Definition
|
|
Term
|
Definition
| lithium carbonate tablets |
|
|
Term
| what is maintenance dose of lithium |
|
Definition
|
|
Term
| ADEs of lithium early on-4 |
|
Definition
| GI, lethargy, polyuria, weight gain |
|
|
Term
| ADEs of lithium long term-4 |
|
Definition
| nephrotoxic, thyroid dysfunction, derm, decrease libido |
|
|
Term
| predisposing factor for toxic ADEs of lithium |
|
Definition
|
|
Term
| mild toxicity of Li ADEs-2 |
|
Definition
| memory difficult, hand tremor |
|
|
Term
| moderate severe toxicity of Li I(1.5-3) ADEs-3 |
|
Definition
|
|
Term
| severe Li toxicity is concentraitn above |
|
Definition
|
|
Term
| ADEs of Li sevre toxicity-2 |
|
Definition
|
|
Term
| what are the major drug interacitons with Li? |
|
Definition
ACEi
NSAIDs/Cox 2 inhb
Diuretics (thiazides esp) |
|
|
Term
what ppl are contrainadicated for Li?
what ppl do you use with caution?-2 |
|
Definition
preggo
renal and cardio defficiency |
|
|
Term
| monitoring for Li look on one note |
|
Definition
|
|
Term
| when first initaitng Li, take non steady state conc every _ days |
|
Definition
|
|
Term
| when starting Li when do you obtain steady state conc? |
|
Definition
|
|
Term
| when deisred Li blood level achieved, need to get level evrt _ weeks for _ months |
|
Definition
|
|
Term
| one pt is maintained on Li dose, need to get levels how often? |
|
Definition
|
|
Term
| when measuring Li, do you get trough or peak? |
|
Definition
| trough (12 hrs after dose) |
|
|
Term
| acute manic ppl have increased/decreased Li excretion |
|
Definition
|
|
Term
| how long does it take Li to reach steady state? |
|
Definition
|
|
Term
| alwyas need to get Li level 5 days ater what? -3 |
|
Definition
dose change
add/disct drug that affected clearence
renal funct change |
|
|
Term
| what is therpuetic level for divalproex |
|
Definition
|
|
Term
| do you get trough or peak levels for divalporex? |
|
Definition
|
|
Term
| when do you get free levels of divalproex conc? -3 |
|
Definition
| low ablumin, renal imparied, have high prot bound meds |
|
|
Term
|
Definition
neurotxic
rash
pancreatitis
osteopenia
hepatotxicity |
|
|
Term
| ADE specifc for valproate-4 |
|
Definition
| thombocytopenia, GI, alopecia, PCOS |
|
|
Term
| valproate can do what to protein bound drugs |
|
Definition
| displace- increase free form |
|
|
Term
valproate is a _ inhibtior
what drug interaction is big with this |
|
Definition
|
|
Term
| what drugs cna increase valproate clearence |
|
Definition
|
|
Term
| start divalproex at _ mg/kg/day. increase every _ days to max of? |
|
Definition
|
|
Term
| contraindicaitons for divalproex |
|
Definition
| preggo, thrombocytopneia, liver disease, pnacreatitis |
|
|
Term
| look at monitoring for all the drugs... |
|
Definition
|
|
Term
| what is teh therapeutic conc for carbamezapine |
|
Definition
|
|
Term
| do you get peak or trough for carbamezapine:? |
|
Definition
|
|
Term
| what increase bioavaialbility of carbamezapine? |
|
Definition
|
|
Term
| what metabolizes carbamezapine to active form |
|
Definition
|
|
Term
|
Definition
neurotox
hepatatox
osteopenia |
|
|
Term
| what ADE is sepcific for carbamezapine |
|
Definition
|
|
Term
| disct carbamezapine if WBC< and ANC< |
|
Definition
|
|
Term
| what drug is an autoinducer adn conc will decrease in first month |
|
Definition
|
|
Term
| carbamezapine is a _ inducer |
|
Definition
|
|
Term
| what are 2 drugs that interact with carbamezapine |
|
Definition
valproic acid
oral contraceptives |
|
|
Term
start dosing of carbaemzapine at-
max of? |
|
Definition
|
|
Term
| contradinciaitons for carbamezapine |
|
Definition
| preggo, immunocompromised, liver disease |
|
|
Term
| what are better for acute mania, mood stabilziers or antipsychotics? |
|
Definition
|
|
Term
| antispychotic use leads to less what rates |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| stevens johonsons, toxic necrolysis, CNS depression, GI |
|
|
Term
| what drugs increase lamotrigine clearence |
|
Definition
|
|
Term
| valproate increases risk for _ when used with lamotrigine |
|
Definition
|
|
Term
| lamotrigine can induce what? |
|
Definition
|
|
Term
| what drugs decrease lamotrigine due to induced glucoridination? |
|
Definition
|
|
Term
| look at dosing for lamotrigine (2 diff ways) |
|
Definition
|
|
Term
| what speicfic things do you use Benzodiazepines for? |
|
Definition
|
|
Term
| what type of antidepressant have higher risk for changing pt to mania? |
|
Definition
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