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Psychopharm Bipolar
| Question | Answer |
|---|---|
| What is the mechanism of action for anticonvulsant mood stabilizer | Neuronal membrane stabilization |
| How is Lithium Metabolized | It's not |
| Lithium for Mania | Affects sx in acute phase (not as good for atypical, mixed) |
| Lithium for Depression | 1st line monotherapy (prophylaxis) |
| Common side effects for Lithium | Tremor, incoordination, nystagums, muscle weakness, goiter, hypothyroidism, weight gain |
| Lithium affects pregnancy | Teratogenicity |
| Target blood level for Lithium | .8-1.2 |
| lithium with an antipsychotic or valproate with an antipsychotic are for what kind of episode | manic/mixed |
| lithium or lamotrigine for what kind of episode | depressive |
| What is the problem with using AD's w/BP depression | flipping/switching |
| Lithium, lamotrigine, olanzapine are used for what in Bipolar? | depression |
| Lithium, valproate, carbamazepine, haloperidol, and all new generation antipsychoticsare used for what | mania/mixed |
| Lithium, lamotrigine, valproate used for what? | Mood stabilization prophylaxis |
| The trade name for Carbamazepine? | Tegretol |
| Adverse effects of Carbamazepine | Sedation, ataxia, visual disturbances, skin reactions, cognitive impairments |
| carbamazepine pharmakinetics are what? | produces it's own metabolism |
| Mechanism of action for Tegretol is what? | Inactivates voltage-sensitive sodium channels |
| 3 indications for Carbamazepine? | Partial, tonic-clonic seizuresTrigeminal neuralgiaAdjunct to lithium(prophylaxis BD) |
| Common side effects CBZ | SedationDry mouth, blurred vision, constipationRashTremorsLeukopenia, agranulocytosisTeratogenic effects (spina bifida, heart defects, developmental delays)Toxicity |
| Severe side effects CBZ | Reduction in white blood cell count (leucopenia--> benign, agranulocytosis--> severe) |
| Because _____ is an auto inducer, drug interactions are likely (thus making other drugs ineffective) | carbamazepine |
| Why does a drug taken with another drug become ineffective? | It's a result of drug-induced stimulation of drug-metabolizing enzymes (CYP-3A4, especially) |
| Why would it be better to take CBZ over Lithium? | Less cognitive impairment |
| What is the trade name for Oxcarbazepine | Trileptal |
| Why is Oxcarbazepine better than CBZ? | It does not induce haptic enzymesIt's "safer" (no enzyme induction, leukopenia, or hepatic toxicities)It's an analogue to CBZ |
| What is the generic name for Depakote | Valproic Acid |
| What aer the 3 mechanism of action for Valproic Acid | 1) binds to and inhibits GABA transaminase (enzyme that breaks down GABA)2) blocks reuptake into glia and nerve endings (thus increasing GABA)3) suppresses repetitve neuronal trhough inhibition of voltage-sensitive sodium channels |
| Drug-drug interactions for Depakote | Only major AED that does NOT induce hepatic microsomal enzymes. |
| Common side effects for Valproic Acid | Less cognitive impairmentGI distress, weight gain, liver signsTremorsSedationHair loss |
| Serious side effects for Valporic Acid | hepatotoxicity (liver damage)pancreatitisTeratogenicity |
| What can depakote be used for | PTSDpersonality disorders (bx dyscontrol) |
| Gabapentin is the generic of waht | Neurontin |
| Gabapentin is what type of drug | Anticonvulsant |
| Besides BP what else is Nuerontin used for? | anxietyneuropathic painsubstance dependencybx dyscontrol |
| What drug is a GABA analogue, but has little or no action on the GABA receptor | Gabapentin |
| __________ is a derivative of Gabapentin | Pregabalin |
| What is the most likely mechanism of action for both gabapentin and pregablin | They decrease the influx of calcium channels, thus less neurtransmitters are released (thus producing antiepiletpic, analgesic, & anxiolytic effects) |
| The pharmacokinetic profile for gabapentin is what | does not bind to plasma proteinsnot metabloziedfew drug-drug interactions |
| Waht is the problem with using Gabapentin? | It is not an effective monotherapy |
| What third-generation anticonvulsant has been accepted as one of the better monotherapeutic drugs for treating acute BP depression & rapid-cycling (& prevention of BP) | Lamotrigine (Lamictal) |
| What is the major MA (mechanism of action)for Lamotrigine | blocking voltage-dependent sodium-channel conductanceinhibits depolarazation of the glutaminergic presynaptic membraneSOOOOO it's a glutamate inhibitor (cortex, hippocampus) |
| Side effects of lamotrigine | dizzinesstremorsomnolenceheadachenasuearash |
| Severe side effects of lamotrigine | rash can become fatal |
| What is the important difference b/w Lamotrigine and other antiepileptic drugs | can IMPROVE cognitive functioning |
| What is the DOC for a pregnant woman? | Lamootrigine |
| What are the different MA of the anticonvulsant, Topriamate? | Inhibitory effect on sodium conductance (thus decreasing APs)Enhances GABA (we don't know how)blocks AMPA subtype glutamate receptor |
| what is the main advantage of taking Topriamate | Weight loss (vs gain...so will help w/comorbid bulimia) |
| What is the biggest drawpback to taking Topriamate | More cognitive impairment than other anticonvulsants |
| What are the pharmakinetics of Topriamate | excreted unchanged, thus has little interaction with drug interactions mediated by liverit can increase plasma levels of other drugs (increase kidney stones) |
| Zonisamide's mechanisms of action are waht | reduction of neuronal repetitive firing by blocking sodium channels and preventing neurotransmitter release--prevents the influx of calcium ions--nueroprotective effects |
| What drug was not shown to be effective | Tiagabine |
Created by:
mandy1335
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