NAPLEX Bipolar Disorder

Define Bipolar 1 & 2

1: Episodes of mania + episodes of intense depression

2: episodes of hypomania + depressive episodes

What is the survey used to diagnose bipolar disorder?

DSM-5

Traditional mood stablizers treat both mania and depression without inducing either side. List a few examples.

Lithium, valproic acid, lamotrigine, carbamazepine

What type of antipsychotics are preferred for bipolar disorder?

Second-generation

Antidepressants can induce or exacerbate which part of bipolar disorder when used as monotherapy?

Mania

In what combination should antidepressants be used in bipolar disorder?

In combination with a mood Stablizer

For ACUTE treatment of mania, what are the first-line treatments?

An antipsychotic, lithium, or valproic acid

For ACUTE treatment of depression, what is the first-line treatment?

An antipsychotic

What piece of paper is required to be dispensed with all antidepressants and antipsychotics?

A MedGuide

What risk/adverse effect is associated with lamotrigine if titrated too quickly?

Severe rash

What are some examples of second-generation antipsychotics used for bipolar disorder?

Aripiprazole

Olanzapine

Quetiapine

Risperidone

Ziprasidone

Lurasidone

What is the MOA of lithium?

Influences reptake of serotonin and norepinephrine in the brain

OR

moderating glutamate levels in the brain

What is the therapeutic trough range of lithium?

0.6-1.2 mEq/L

Due to its MOA, what is an expected warning for lithium?

Serotonin syndrome

In addition to lithium levels, what two labs should be monitored in lithium treatment?

Renal Function & Thyroid function

Is lithium safe or unsafe in pregnancy?

Unsafe!

What are some side effects of lithium?

Dehydration, GI upset, cognitive effects, tremor, thirst, weight gain, hypothyroidism

Drug Interaction: Lithium levels increase with…

Decreased salt intake

ACE inhibitors/ARBs, thiazide diuretics

Drug Interaction: Lithium levels decrease with…

Increased salt intake

Caffeine

When combined with the following agents, the risk of neurotoxicity increases when taking lithium

Verapamil, Diltiazem

Phenytoin, Carbamazepine

What 3 bipolar agents SHOULD NOT be used in pregnancy?

Valproic Acid, Carbamazepine, Lithium

Which drug has the most favorable safety profile to treat bipolar depression in pregnancy?

Lurasidone

**ONLY TREATS BIPOLAR DEPRESSION