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Pharmacology test 5
Muscle relaxants - mood disorder meds
219
Health Care
Graduate
11/17/2008

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Cards

Term
muscle spasm
Definition
involuntary contraction of a muscle or muscle group. Usually painful and decreases one's level of functioning.
Term
how do you treat muscle spasms?
Definition

1. immobilization of affected muscles

2. cold compresses

3. physical therapy

4. drug therapy

Term
muscle spascity
Definition

a velocity-dependent increase in resistance to passive movement that affects different muscles to a different extent

 

 

 

Term
muscle spascity is usually due to...
Definition

CNS damage

post stroke

Term
how do you treat muscle spascity?
Definition

physical therapy

drug therapy

Term
what should you not do to treat muscle spascity?
Definition
do not ice
Term
which muscle relaxants are approved to treat muscle spascity?
Definition

baclofen

dantrolene

tizanidine

Term
which drugs are skeletal muscle relaxants?
Definition

baclofen

carisoprodol

chlorozoxazone

cyclobenzaprine

dantrolene

metaxalone

methocarbamol

orphenadrine

tizanidine

Term
what are some common conditions associated with muscle spascity?
Definition

Multiple Sclerosis

Spinal Cord Injury

Traumatic Brain Injury

Cerebral Palsy

Post Stroke Syndrome

Term
what are some common musculoskeletal conditions that can cause tenderness and muscle spasm?
Definition

fibromyalgia

tension HAs

myofascial pain syndromes

mechanical pain (low back or neck)

Term
what is cyclobenzaprine indicated for?
Definition
relief of acute muscle spasm caused by local tissue trauma or muscle strain
Term

What are some cyclobenzaprine contraindications?

Definition

MAOI use in the last 14 days

persons w/ a recent MI,

cardiac dysrhythmias

or overactive thyroid

 

Do not drink alcohol while taking

bc it can be additive to the SEs

Term

if cyclobenzaprine is prescribed for >1, what do you need to make sure you do?

Definition

taper the dose when discontinuing

 

this prevents HAs, nausea and general discomfort

Term
cyclobenzaprine SEs
Definition

antimuscarnic effects

may cause significant sedation

confusion

transient visual hallucinations

potential for cardiac toxicity

Term
cyclobenzaprine pregnancy category
Definition
B
Term
what age groups is cyclobenzaprine not good for?
Definition

children <12

the elderly may be more sensitive to the SEs

overdose may be fatal for them

 

Term
how long should cyclobenzaprine be prescribed for?
Definition
usually no more than 3 wks
Term
muscle relaxants should be used in conjunction with...
Definition
rest and physical therapy to receive maximal benefit
Term
chlorzoxazone works to a greater degree at the _____________ than does cyclobenzaprine.
Definition
spinal cord level
Term
chlorzoxazone works by...
Definition
blocking nerve impulses sent to the brain from the painful muscle fibers
Term
chlorzoxazone SEs
Definition

dizziness

lightheadedness

malaise

 

rarely hyperstimulation,

skin rashes

petechiae/ecchymoses

 

serious hepatocellular toxicity (not predictable)

Term
when you put a pt on chlorzoxazone, you should advise them to report what symptoms?
Definition

fever

N/V/D

RUQ pain

dark urine

jaundice

Term
Chlorzoxazone: concomitant use of ___________ and ________ may have an additive effect.
Definition
alcohol and CNS depressants
Term
how does carisoprodol work?
Definition
centrally by blocking pain sensations btwn the nerves and the brain
Term

Methocarbamol SEs

Definition

CNS depressant SEs

bradycardia

hypotension

syncope

mild GI SEs

 

 

Term
methocarbamol may inhibit the effects of _________________
Definition

pyridostigmine

 

don't use in pts with MG who are being treated w/ it

Term
which muscle relaxant should be given in conjunction with a high fat meal to allow for a more complete absorption (but shorter half life)?
Definition
metaxalone
Term
methocarbamol should not be prescribed for women who...
Definition
are or may become pregnant
Term
SEs of metaxalone include:
Definition

CNS drowsiness

dizziness

HA

N/V

hematologic leukopenia, hemolytic anemia

Term
which muscle relaxant has an anxiolytic metabolite called meprobamate?
Definition

Carisoprodol

 

this metabolite is probably why its addictive

Term
Contraindications of carisoprodrol
Definition

pts w/ liver or kidney disease

or w/ history of seizures

 

must use a lower dose

Term
Carisoprodol SEs
Definition

CNS depressant effects

tachycardia

postural hypotension

 

use in great caution in a pt w/ an addictive history

Term
ALERT for carisoprodol
Definition

the first dose has been followed by extreme weakness, transient quadriplegia, ataxia, diplopia, dysarthria and disorientation

 

ideally give them their first dose in the office or make sure they take it at home with someone there, so you can see what happens

Term
which muscle relaxant has the broadest spectrum?
Definition
orphenadrine
Term
orphenadrine MOA
Definition

NMDA receptor antagonist belonging to the ethanolamine class of antihistamines; isomer of diphenhydramine -- has anticholinergic effects

 

 

Term
which muscle relaxant is in the same group as benedryl?
Definition
orphenadrine
Term
in addition to orphenadrine's skeletal muscle relaxant properties it also has...
Definition

analgesic and local anesthetic effects

(used to augment other analgesics in chronic pain management)

Term
orphenadrine SEs
Definition

CNS depression

dry mouth

abd cramps

blurred or double vision

constipation

difficult urination

(bc it has anticholinergic effects)

Term
orphenadrine contraindications
Definition

glaucoma

stomach ulcers

myasthenia gravis

enlarged prostate

Term
which muscle relaxant is closely related to TCAs?
Definition

cyclobenzaprine

 

(problems with cardiac dysrhy)

Term
which muscle relaxant is addictive and controlled in KY?
Definition
carisoprodol
Term
which muscle relaxant is hepatotoxic?
Definition
chlorzoxazone
Term
antihistamines can cause what at both ends of the age spectrum?
Definition
euphoria
Term
what is orphenadrine derived from?
Definition
diphenhydramine
Term
what does dose vary with?
Definition

drug

route of administration

purpose

Term
for the most part muscle relaxant MOA is __________, but is related in part to their _____________.
Definition

unclear

sedative properties

Term
which drug for muscle spasicity is a derivative of GABA and is an agonist at GABAb?
Definition
baclofen
Term
baclofen is indicated for:
Definition

treatment of:

spinal cord injuries

MS

ALS

trigeminal neuralgia

Term
baclofen MOA
Definition
acts within the spinal cord to suppress reflexes involved in regulating and controlling muscle mvt and can be administered orally or intrathecally
Term

baclofen SEs

Definition

CNS depression

mild GI

 

withdrawl sxs if withdrawn too rapidly

Term
dantrolene MOA
Definition

acts directly on the skeletal mm to suppress Ca release from the s. reticulum

 

this decreases ability of mm to contract

Term
why would you use dantrolene?
Definition

to reduce spasticity in

post stroke pts

paraplegics

pts w/ CP and MS

 

specific antidote for malignant hyperthermia

useful in management of neuroleptic malignant syndrome

Term
what is neuroleptic malignant syndrome caused by?
Definition

anti-psychotic drugs

 

lead pipe rigidity and inc body heat

Term
chemically dantrolene is a _____________ derivative
Definition

hydantonin

but its not used in treating seizure disorders

Term
AEs of dantrolene
Definition

HEPATOTOXICITY

mm weakness (most common)

drowsiness, confusion, depression

speech and visual distrubances

diarrhea

Term
which drug for mm spasticity can cause heptatotoxicity?
Definition
dantrolene
Term
dantrolene drug interactions
Definition

dantrolene + CCB can lead to various cardiovascular abnormalities, including dysrhythmias, hyperkalemia

 

estrogens can enhance the liver toxicity of dantrolene

Term
what is the MOA of tizanidine?
Definition
centrally acting alpha-2 adrenergic agonist
Term
tizanidine is used to treat...
Definition

MS

spinal cord injuries

Term
which muscle spasticity drug can cause liver injury, hallucinations and delusions?
Definition
tizanidine
Term
if you use tizanidine for an extended period of time what do you run the risk of?
Definition

withdrawl

rebound hypertension

tachycardia

Term
what is acute anxiety?
Definition
an adaptive response that prepares one to react to threatening events
Term
what is the difference btwn fear and anxiety?
Definition

fear is in response to something that is known

anxiety is in response to something that is unknown

Term
what are some characteristics of anxiety?
Definition

physiologic arousal

apprehension and/or fear

hypervigilance

Term
what is chronic anxiety?
Definition
a maladaptive response to psychological stress
Term
what are some characterisitics of chronic anxiety?
Definition

physical sxs such as diarrhea, sweating, tremors, dizziness, palpitations

 

long term may contribute to heart disease, or substance abuse

Term

how does the amygdala mediate the manifestations of anxiety?

Definition
by potentiating the memory of AEs that establish anticipatory anxiety
Term
what are the 2 components of the experience of anxiety?
Definition

1. awarenss of the physiological sensations

eg sweating and palpitations

 

2. awareness of being nervous or frightened

Term
what does anxiety affect?
Definition

thinking

perception

learning

Term
anxiety tends to produce:
Definition

confusion and distortions of perceptions

 

not only of time and space but of people and the meaning of events

Term
what are the 3 major NTs assc with anxiety?
Definition

NE

Serotonin

Gamma-aminobutyric acid (GABA)

Term
which NT has a lot to do with emotions?
Definition
serotonin
Term
how do we know that GABA is affects anxiety?
Definition

bc of the efficacy of benzodiazepines

which enhance activity of GABA in the txt of some anxiety disorders

Term
about ___ of all pts with panic disorder have a least ___ affected relative
Definition

1/2

 

1

Term
what are some examples of anxiety disorders?
Definition

panic disorder w/ or w/o agoraphobia

agoraphobia w/o panic disorder

specific and social phobias

OCD

PTSD

anxiety due to general medical condition

substance induced anxiety disorder

anxiety not otherwise specified

Term
how do you manage anxiety disorders?
Definition

first, make the correct diagnosis

psychotherapy

pharmacotherapy

Term
which benzodiazapines are anxiolytics?
Definition

diazepam

alprazolam

lorazepam

clorazepate

chlordiazepoxide (1st one)

Term
which benzodiazepines are hypnotics (sleeping pills)?
Definition

oxazepam

temazepam

triazolam

flurazepam

estazolam

Term
which benzos are for seizures?
Definition

clonazepam

diazepam

Term
which benzos are used as an anesthetic?
Definition
just midazolam
Term
which benzos are frequently used in alcohol detox units?
Definition

chlordiazepoxide

lorazepam

oxazepam

Term
which benzo is also prescribed for muscle relaxation?
Definition
diazepam
Term

how should you choose which benzodiazepine to use?

Definition
based on its onset and duration of action
Term
how are benzos metabolized?
Definition

in the liver either by:

P450 system

or phase II conjugation

Term
which benzos are metabolized by conjugation?
Definition

lorazepam

oxazepam

temazepam

 

safer for use in the elderly

Term
which benzos are safer for use in the elderly?
Definition

those metabolized by conjugation

 

lorazepam

oxazepam

temazepam

Term
what is the MOA of benzos?
Definition

bind to receptors on the GABAa-chloride ionophore

 

they cause channels to open more frequently, more Cl gets to go through

hyperpolarizes

 

secondly (minor) increases the inhibitory effect of adenosine on neurons that release ACh, thought to cause arousal

Term

lower doses of BZDPs are ______________

higher doses produce _______________

Definition

sedative and anxiolytic

 

hypnosis and anesthesia

Term
if you pick the right drug, what can BZDPs do?
Definition
relieve anxiety w/o causing much sedation
Term
when would BZDPs cause resp depression, coma or death?
Definition
when they are combined with other CNS depressants
Term
which group of drugs can cause retrograde amnesia?
Definition

BZDPs

 

they interfere with the formation of new memories

Term

AEs of BZDPs

Definition

CNS depression

impair cognitive processing

interfere w/ driving and other psychomotor skills

long acting drugs may cause drug hangover

respiratory depression w/ IV admin

 

mild euphoric effect which leads to behavioral inhibitions

long term use may lead to physical dependence

Term
what is the antidote for BZDPs?
Definition

flumazenil -- Romazicon

 

SEs

seizures, dysrhythmias, blurred vision, dizziness

Term
why would you use BZDPs?
Definition

to treat:

anxiety disorders

insomnia

muscle spasm/spasticity

seizure disorders

alcohol detox

panic disorders

anesthesia

Term
what is the MOA of barbiturates?
Definition

1. bind to GABAa-chloride ionophore to increase affinity

 

2. increase the duration of time the channel remains open

 

3. directly increases chloride influx

Term
which is the difference in the MOAs btwn BZDPs and barbiturates?
Definition

barbiturates not only bind to the GABAa-chloride ionophore but

 

it also keeps the Cl channel open longer

and increases the chloride influx

Term
what makes barbiturates pretty toxic?
Definition

it has a linear dose-response curve

 

as the dose increases the pt progresses in sedative effects from sedation to resp depression to coma to death

Term
which barbiturate is most frequently used?
Definition

phenobarbital

(antiseizure med)

Term
which drugs are barbiturates?
Definition

pentobarbital

thiopental

amobarbital

secobarbital

phenobarbital

Term
which barbiturate is most likely to be abused?
Definition
amobarbital
Term

are BZDPs or barbiturates more toxic and sedating?

Definition
barbiturates
Term
how do the barbiturates effect sleep?
Definition

the suppress REM sleep

Term
why do you need to taper pts off barbiturates slowly?
Definition
bc they can cause tolerance and physical dependence// withdrawl syndrome
Term
which disorder do barbiturates exacerbate?
Definition

prophyria

 

where you can't metabolize bilirubin

Term
why do barbiturates have a lot of drug interactions?
Definition

bc they are metabolized by the P450 system

and may induce their own and other drug's metabolism

Term
which barbiturates are used for the txt of insomnia?
Definition

pentobarb

secobarb

 

(they are schedule 2)

Term
which barbiturate is known as the "truth serum"?
Definition

thiopental

 

sometimes used before induction of anesthesia

Term
SEs of barbiturates
Definition

euphoria

elation

uninhibited behavior

 

(makes them candidates for abuse)

Term
which barbiturate is a schedule 4?
Definition
thiopental
Term
larger doses of barbiturates can do what?
Definition

depress the respiratory and nervous system functions

 

abusers rapidly develop a tolerance

thus fatal overdose or coma can easily occur

Term
what occurs with withdrawl syndrome from barbiturates?
Definition

anxiety                               tachypnea

irritability                            tachycardia            

muscle pain                         tremors

Nausea                               hallucinations

confusion                            seizures

death                                 insomnia

vivid dreaming                     nightmares

]

Term
which hypnotic is the most used in the hospital?
Definition

antihistamines

like benedryl

 

its capitalizing on a SE

Term
zolpidem MOA
Definition
works similar to BZDPs by activating the omega1 BZDP receptor on the GABAa-chlorine ionophore
Term
how does zolpidem (ambien) effect sleep?
Definition

preserve deep sleep

 

no significant effect on REM sleep

Term
why is zolpidem good if you pt says they can't fall asleep?
Definition

bc it has a rapid onset and short duration of action

Term
how long should you use zolpidem?
Definition
7-10 days
Term
what should you not use when you are on zolpidem?
Definition

ETOH

other CNS depressants

Term
what schedule are the hypnotic drugs (excluding antihistamines)?
Definition
C IV
Term
zaleplon (sonata) has similar actions and effects to what other drug?
Definition

zolpidem

Term
when would you use zaleplon?
Definition

in a pt who is having problems falling asleep

 

it does not increase sleep duration

Term
what is the recommended duration of txt of zaleplon?
Definition
2 wks
Term

zaleplon SEs

Definition

anterograde amnesia

tolerance

physical and psychological dependence

Term
how is zaleplon metabolized?
Definition
P450 system
Term

Eszopiclone (lunesta)

 

Definition

MOA unknown; probably interacts w GABA receptors

 

a new chemical class of hypnotics

appears to be quite safe

short term only

45 minutes before bed

Term
about what percentage of people w/ depression show improvement with ANY of several antidepressant meds?
Definition
80%
Term
combining antidepressant drugs with _____________ is synergistic
Definition
psychotherapy
Term
which TCAs are the most common?
Definition

amitriptyline

desipramine

nortriptyline

imipramine

clomipramine

doxepin

Term
what do TCAs generally end in?
Definition

-triptyline

-ipramine

Term
TCAs are sometimes used as adjuncts in...
Definition
treating pain syndromes
Term
TCA MOA
Definition

blockade of reuptake of either NE or serotonin from the synapse back into the nerve terminal

 

w/o blocking the reuptake of dopamine

Term
are TCAs more potent at blocking the reuptake of NE or serotonin?
Definition
NE
Term
TCAs have may active __________
Definition

metabolites

(potential for drug interactions)

Term

most TCAs are extensively...

Definition
protein bound
Term
why are they called TCAs?
Definition
bc of their triple ring structure
Term
as a rule, TCAs have ______ half-lives
Definition

long

ranging from 1-3 days

Term
TCAs improve depressive illnesses in ____% of pts?
Definition
65-80%
Term
how long does it normally take for TCAs to have their maximal effect?
Definition
1-3 months
Term
disturbing TCA SE
Definition

propensity to commit suicide

Term
typical TCA SEs
Definition

sedation

wt gain

dry mouth

constipation

urinary retention

blurred vision

memory impairment

sinus tachycardia

orthostatic hypotension

Term
which TCA SE is potentially a severe problem in the elderly?
Definition
orthostatic hypotension
Term
if pts have reexisting cardiac problems, what can be seen with TCA use?
Definition
AV and BBB or PVCs
Term
which SE is likely to make TCA users less compliant?
Definition

wt gain

and sexual dysfunction

Term
what is an important central SE of TCAs?
Definition
induction of mania or hypomania in depressed pts with bipolar disorder
Term
TCA-induced toxicity of the CNS can produce...
Definition

delirium

which is preceded by a worsening of the depression or psychosis

Term
poisoning accounts for ____ of all suicides and ____ are the most commonly used drugs in these victims.
Definition

20%

TCAs

Term
what can TCA overdose cause?
Definition

coma

cardiac dysrhythmias

death

Term
what is a lethal dose of TCA?
Definition
no more than 10-20 times greater than a standard daily dose
Term
what pregnancy category are TCAs?
Definition

C

 

except for imipramine, nortriptyline and amitripyline which are D

Term

which drug interaction w/ TCA is very serious?

Definition

TCA + MAOIs

 

make sure you have a 2 wk wash out

Term
what is the difference btwn SSRIs and TCAs?
Definition

SSRIs are selective for serotonin reuptake

have less SEs and cause less sedation

but just as effective

 

TCAs are nonspecific for NE and serotonin reuptake

Term
what is the prototype for SSRIs?
Definition
fluoxetine (prozac)
Term
SSRI drugs
Definition

fluoxetine

paroxetine

fluvoxamine

citalopram

escitalopram

Term
are all SSRIs structurally similar?
Definition
nope
Term
which drugs are first choice for people with depression?
Definition
SSRIs
Term
why don't SSRIs make you drowsy?
Definition
bc they have little to no affinity for cholinergic, beta adrenergic or histamine receptors
Term
why should SSRIs be taken first thing in the morning?
Definition
bc they are excitatory
Term

SSRIs are well tolerated by the ____________

Definition
elderly
Term
how long may it take for SSRIs to have their maximal effect?
Definition
about 1 month
Term
SSRI AEs
Definition

increased alertness

nervousness, dizziness, insomnia, and

male sexual dysfunction

 

many SEs subside with continued use

Term
SSRIs should be used with caution in pts with...
Definition

seizure disorders

hepatic disorders

bipolor disorders

Term

how are SSRIs metabolized?

Definition
P450 system
Term
what is unique about fluoxetine?
Definition

it has a 60 hours half life

and an active metabolite with a half life of 192 hours

 

not used as much as the other SSRIs

Term
if you want to switch a pt from a MAOI to a SSRI and vice versa how long must the wash out period be?
Definition
at least 2 weeks
Term
why would you use SSRIs?
Definition

depression

eating disorders

anxiety disorders

 

fibromyalgia

autism

PMS

Term
which SSRI is assc with more drug interactions than any other?
Definition
fluoxetine
Term
Fluoxetine has caused ________ in some pts -- watch out for persistant _______________
Definition

SIADH

hyponatremia

Term
which SSRIs has the fewest drug interactions?
Definition
citalopram
Term
which SSRI can inhibit its own metabolism?
Definition
paroxetine
Term
which SSRI is more sedating than the others?
Definition

paroxetine

 

which makes its good for combination of anxiety and depression

Term
which SSRI is your last choice?
Definition

fluvoxamine

lots of DIs

Term
which SSRI may have more GI effects?
Definition
sertraline
Term
abrupt discontinuation of _____________ is assc with a flu-like syndrome
Definition
paroxetine - SSRI
Term
Escitalopram is an isomer of ___________
Definition
citalopram
Term
which SSRIs would you use for OCD?
Definition

fluvoxamine

paroxetine

sertraline

fluoxetine

Term
which SSRIs would you use to treat GAD?
Definition

just escitalopram

Term
which SSRIs would you use to treat bulimia?
Definition

fluoxetine

fluvoxamine

Term
which SSRIs would you use to treat panic disorders?
Definition

fluoxetine

paroxetine

sertraline

fluvoxamine

Term
which SSRIs are used to treat PMDS?
Definition

fluoxetine

paroxetine

sertraline

Term
which SSRI is used to treat BDD?
Definition
fluoxetine
Term
which SSRI is used to treat PTSD and social anxiety?
Definition
sertraline
Term
which SSRI is used to treat hypochondriasis?
Definition
fluoxetine
Term
do not __________ SSRIs
Definition
abruptly discontinue
Term
Venlafaxine MOA
Definition

inhibits reuptake of serotonin, NE and +- DA

 

no significant P450 effects

 

antidepressant

Term
duloxetine MOA
Definition

classified as an SSNRI

 

antidepressant

Term
duloxetine indications
Definition

depression

diabetic peripheral neuropathic pain

Term
duloxetine SEs
Definition

most common = nausea

 

dry mouth

constipation

dec appetite

increased sweating

Term
duloxatine + MAOI =
Definition
cause be fatal
Term
mirtazapine MOA
Definition

antidepressant

 

blocks presynaptic alpha2-adrenergic receptors

selectively antagonizes serotonin 2&3 receptors

 

usually adjunctive

 

Term
mirtazapine is metabolized by:
Definition
the P450 system
Term
Mirtazapine indications
Definition

depression

adjunctive for resistant depression

depression w/ anxiety

preoperative anxiety

depression w/ insomnia

Term
SEs of mirtazapine
Definition

drowsiness

dry mouth

inc appetite

wt gain

dizziness

elevations in cholesterol, trigs and ALT

 

agranulocytosis (bone marrow suppression)

low incidence of sexual dysfunction

Term
if you are taking mirazapine and you get a __________ you should come in
Definition
sore throat
Term
trazodone is ____________ unrelated to other antidepressants
Definition
chemically
Term
trazadone MOA
Definition

not fully understood

inhibits serotonin uptake

Term
trazodone SEs
Definition

drowsiness

other typical CNS effects

priapism

Term
trazodone indications
Definition

depression

insomnia

anxiety (they respond early here)

Term
what is trazodone usually prescribed for?
Definition
insomnia
Term
bupropion is __________ to other antidepressants
Definition
unrelated
Term
bupropion MOA
Definition

weakly inhibits reuptake of NE and serotonin

 

major effects is inhibition of dopamine reuptake pumps

 

few anticholinergic, sedative or CV SEs

Term
which type of bupropion helps people quit smoking?
Definition
zyban
Term
Bupropion SEs
Definition

agitation

insomnia

tremor

 

rarely seizures 

Term
bupropion indications
Definition

depression

SAD

quitting smoking 

Term
Phenytzine
Definition

MAOI

 

rec for use with atypical depression or typical depression when others fail

 

lots of food and drug interactions

 

 

Term
selegiline
Definition

MAOB inhibitor

 

transdermal patch

 

at higher doses it loses its selectivity 

Term
what is one of the most severe forms of mental illness?
Definition
bipolar disorder
Term
bipolar disorder is characterized by...
Definition
recurrent episodes of mania and (more often) depression
Term
if bipolor disorder goes untreated, what is the rate of suicide?
Definition
~15%
Term
bipolar disorder is ________________ and runs in _____________
Definition

life long

 

runs in families 

Term

bipolar Sxs

for mania 

Definition

increased energy, activity and restlessness

overly good, euphoric mood

extreme irritability

racing thoughts

distractibility

little sleep needed

unrealistic beliefs in one's abilities and powers

poor judgment

spending sprees

increased sexual drive 

abuse of drugs, alcohol and sleep meds

provocative, intrusive, aggresive behavior

denial that anything is wrong 

Term
how do you diagnose a manic episode?
Definition
if elevated mood occurs with 3+ of the sxs most of the day, nearly every day, for 1 week or longer
Term
A depressive episode is diagnosed if...
Definition
5+ of the sxs last most of the day, nearly every day, for a period of 2 weeks or longer
Term
what is rapid cycling bipolar?
Definition
when 4+ episodes of illness occur within a 12-month period
Term
what is the most commonly used drug for bipolar?
Definition

lithium

 

followed by carbamazepine and valproic acid 

Term
in mania a __________________ and/or ____________ is often added to the mood stabilzer?
Definition

antipsychotic

BZDP 

Term
Bipolar: in depression a ______________ and/or ____________ is often added to the mood stabilzer
Definition

antidepressant

lamtragine 

Term
what drugs can trigger mania?
Definition
antidepressants
Term
lithium MOA
Definition

increases the uptake of NE and serotonin and thereby reduces their actions

 

it reduces release of NE from synaptic vesicles and inhibits production of cAMP 

Term
what do you need to make sure does not change when prescribing lithium?
Definition
Na intake
Term
why is lithium often seen taken with synthroid and a beta blocker?
Definition

bc the synthroid is used to treat the hypothyroidism caused by lithium

 

and the beta blocker is used to treat the hand tremor caused by lithium 

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