Term
| What is the main difference between Bipolar Disease (BD) and Major Depression? |
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Definition
| In BD it is a cycle of Depression and Mania whereas in major depression there is only depression. |
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Term
| T/F: BD is a lifelong illness that requires both nonpharmacological and pharmacological Tx for mood stabilization. |
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Definition
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Term
| What is considered Manic? |
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Definition
>1 wk of persistently elevated mood w/ at least 3 of the following Sx:
Pressure to speech, increase in activity, distractable, racing thoughts, increased motor activity, excessive involvement in activities like shopping sprees, decreased sleep, etc |
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Term
| The prevalence of BD increaes during _________________. |
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Definition
| Late teens, early adulthood |
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Term
| BD 1 affect men (>, <, =) to women, BD 2 affects men (>, <, =) to women. |
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Definition
BD 1: = (equal incidence)
BD 2: < (less than women) |
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Term
| Is BD associated with any educational, social class, race or nationality? |
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Definition
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Term
| 65% of BD patients met the criteria for a comorbid disorder. What are the two most common disorders? |
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Definition
1. Substance abuse (42%)
2. Anxiety (42%) |
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Term
| What is the difference between BD1 and BD2? |
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Definition
BD1 cycles of Mania and Depression.
BD2 cycles of HYPOmania and Depression |
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Term
| The Accroynm G-I-D-D-I-N-E-S-S describes a manic episode. What do the letters stand for? |
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Definition
G = grandiose
I = increased activity
D = decreased judgement/sleep
D = delusional
I = irritable
N = non attentive
E = elevated mood/ euphoria
S = speedy speech
S = speedy thoughts |
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Term
| The accroynm S-I-G E C-A-P-S describes episodes of depression. What do the letters stand for and how many do you need for at least 2 wks to be considered depressed? |
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Definition
S = sleep disturbance
I = interest (decreased)
G = Guilt (increased)
E = Energy (decreased)
C = Concentration (decreased)
A = Appetite (up or down)
Psychomotor = (up or down)
S = suicidal thoughts
You need at least 5 |
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Term
| T/F: Depressive Sx are experienced longer than manic and there recovery is shorter than manic episodes. |
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Definition
| False: Yes they do have it for longer, but also there recovery is longer than manic. |
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Term
| Which cycle (manic or depressive) do BD patients most often attempt suicide? |
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Definition
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Term
| Lithium and Valproic Acid are considered (1 or 2) line tx options? |
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Definition
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Term
| Which 2 frist generation antipsychotics is approved for acute mania? |
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Definition
1. Chlorpromazine
2. Trifuoperazine |
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Term
| What is the only 2nd generation antipsychotic that is approved for use in acute mania? |
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Definition
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Term
| Why is Li effective for BD? |
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Definition
| Effective as an antimanic, mood stabilizer and depression. |
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Term
| What is the therapetuic levels for Li in normal adults and elderly adults? |
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Definition
Normal: 0.6-1.2 mEq/ml
Elderly: 0.3 - 0.8 mEq/ml |
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Term
| What is the therapeutic level of Li used for prophylaxis? |
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Definition
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Term
| MOA of Li is unknown, but what does it do that might help to stabilize mood? |
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Definition
| In mania there is an increased in IP3 and DAG so Li depletes IP3 and DAG so reduces the response by the NTs |
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Term
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Definition
| No! Its an element! Its renally excreted! |
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Term
| Li is related to renal function. Elderly have a ________ GFR, while prego have a __________ GFR. |
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Definition
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Term
| When should you monitor Li levles? |
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Definition
12 hrs after last dose q 2-3 days until steady state (5 days)
Then q 1-2 wks for 2 mo
Biannually in stable patients |
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Term
| Along with Li levels, what else should you monitor? |
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Definition
Renal function = Q 2-3 mo x 6 mo, 2x/yr after that
Thyroid function = Baseline then at 6 mo, annually afterthat. |
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Term
| Side effects of Li include |
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Definition
1. Polydipsia
2. Polyuria
3. Memory probs
4. Weight gain
5. Tremor
6. Drowsy/tired |
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Term
| What drugs decreaes the renal elimination of Li? |
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Definition
1. Thiazides
2. NSAIDs
3. ACEi
4. COX2i
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Term
| What drugs increase the renal elimination of Li? |
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Definition
1. Caffeine
2. Theophylline |
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Term
| What is the role of Valporate? |
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Definition
| For acute and propylactic tx of mania and depression |
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Term
| Describe the initial dosing of Valporate |
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Definition
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Term
| What do we need to monitor for Valporate |
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Definition
LFTs and CBC
(We want a blood conc of 50-120 ug/mL) |
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Term
| List some ADE of Valporate |
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Definition
1. GI upset
2. Thrombocytopenia
3. Hepatotoxicity
4. Leukopenia
5. Neural tube defects
6. Pancreatitis |
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Term
| What is the role of Carbamazepine in BD? |
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Definition
For Acute and probably prophylactic treatement of mania/hypomania.
Can be used as an adjunct tx w/ other mood stabilizers |
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Term
| How do you dose Carbamazepine? |
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Definition
Start at 200-600 mg/day in divided doses
(dose to max efficacy) |
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Term
| What do you need to monitor with Carbamazepine? |
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Definition
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Term
| Some side effects of Carbamazepine include: |
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Definition
Dizziness
Double/blurred vision
GI distress
Hematopoietic suppression
Hepatatoticity
Impaired task performance
Rash (stevens johnson syndrome)
Sedation |
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Term
| Carbamazepine is an enzyme inducer of which CYPs? |
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Definition
1A2, 3A4, 2C9
Also is a CYP3A4 susbstrate so it induces itself |
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Term
| What are the PROS for first generation antipsychotics? |
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Definition
Fast onset
Cheap
70% effective in acute mania |
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Term
| What are the CONS for 1st generation antipsychotics? |
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Definition
Lack mood stabilizing properities
Higher risk for TD |
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Term
| When should 1st generation antipsychotics be used? |
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Definition
Should be used as adjunctive therapy with a mood stabilizer in acute mania |
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Term
| Which 2 atypical antipsychotic have the most evidence for use in mania? |
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Definition
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Term
| What dose of Olanazapine is efficacious in BD? |
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Definition
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Term
| T/F: Clozapine is particulary effective in refractory illness. |
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Definition
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Term
| When are short term uses of Benzos appropriate? |
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Definition
| If the patient is really aggitated |
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Term
| What do you do when you drug tx fails even when first line tx is optimized? |
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Definition
Add another first line agent
Can add Carbamazepine or Oxcarbazepine as add on therapy |
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Term
| In BD depression, mood stabilizers are 1st line Tx. Which 2 drugs have the strongest evidence supporting there use? |
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Definition
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Term
| Atypical antipsychotics provide benefit for BD depression. Which 2 drugs have the strongest support for there use as monotherapy? |
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Definition
Quetiapine
Olanazpine + Fluoxetine combo
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Term
| The goal for Tx of aucte depression in BD patients is to decrease there depression, but we dont want to cause someone to become manic. Which Antidepressants is least likely to trigger mania? |
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Definition
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Term
| If you give a patient Carbamazapine but does not respond to it, what can you give them? |
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Definition
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Term
| Yes/No: Should you combine antipsychotics? |
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Definition
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Term
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Definition
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