USMLE Step 2 Review 20 11 Drugs of Choice Bipolar Disorder

USMLE Step 2 Review 20 11 Drugs of Choice Bipolar Disorder

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Play USMLE Audio MP3 20 11 Drugs of Choice Bipolar Disorder Meds Below


Begin 20 11 Drugs of Choice Bipolar Disorder Transcription

What are the 3 primary medications used in the treatment of Bipolar disorders that are in the class of mood stabilizers?

  • Lithium, Carbamazepine, Valproic acid.

And the trade name for Carbamazepine?

  • Tegratol.

And the trade name for Valproic Acid?

  • Depakote.

Which of these has traditionally been used most widely and is effective in the acute manic episode?

  • Lithium.

Before making the diagnosis of bipolar disorder and initiating treatment with Lithium, especially in the acute phase, what 2 other possibilities must the physician keep strongly in mind? Mania suggesting Bipolar disorder can be caused by drug abuse and by some medications, and by some medical conditions.

What general class of drug all have the potential of causing symptomatic mania?

  • The antidepressants.

What is important in managing the Lithium patient, to avoid toxicity?

  • Blood levels must be closely monitored.

After Lithium, what is the second FDA-approved agent for the treatment of mania in Bipolar disorder?

  • Valproic acid.

Trade name?

  • Depakote.

Like Carbamazepine (trade name Tegratol), Valproic Acid (trade name Depakote) has what advantage over Lithium? It has a broader spectrum of effectiveness, especially for what 2 types of Bipolar presentations?

  • Mixed states and rapid-cycling.

Which of these 3 that we’ve listed is widely used but is not FDA approved?

  • Carbamazepine.

Trade name?

  • Tegratol.

What 2 advantages does Valproic Acid have over both Lithium and Carbamazepine?

  • First, Valproic acid is safer in overdose, and second, it is less blunting to the personality of the Bipolar patient.

What general class of drugs appear to be the most effective in treating Bulimia nervosa?

  • The selective serotonin reuptake inhibitors; the SSRIs.

And especially which one appears to probably be the drug of choice for bulimia, although it is not FDA-approved?

  • Fluoxetine.

Trade name?

  • Prozac.

If a patient is in delirium, and is also clearly psychotic, what general class of drug is the class of choice?

  • The neuroleptics.

And specifically, what chemical class of the neuroleptics?

  • The butyrophenones.

And why are the butyrophenones the chemical class of choice of the neuroleptics for the patient who is in delirium and who is also clearly psychotic?

  • Because the other neuroleptics and in particular, the phenothiazines, have what type of side effects? Anticholinergic side effects, which can heighten the delirium.

In particular, for the delirious, clearly psychotic patient, what is the butyrophenones drug of choice?

  • Haloperidol.

Trade name?

  • Haldol.

And what should happen to the administration of this drug, as the delirium resolves?

  • This drug should be tapered off over several days. If the patient is delirious, agitated, but not psychotic, sedation overall is what is desired.

And what would be the general class of drug that would be best for achieving the sedation?

  • The short-acting benzodiazepines.

There are many choices in this category, and there isn’t a clear drug of choice, however, one that is mentioned in several texts is?

  • Lorazepam.

Trade name?

  • Ativan.

What is an occasional adverse side effect, however, of attempting to use a short-acting benzodiazepine for sedation?

  • Sometimes, you get the opposite effect- it actually worsens the delirium and increases agitation.

There are a number of drugs that can actually cause depression in the patient. What type of oral contraceptive may sometime cause depression?

  • Contraceptives containing progesterone.

And what 4 types of withdrawal are associated with depression?

  • Withdrawal from amphetamine, cocaine, sedatives, alcohol.

What chemical class of the neuroleptics is most commonly associated with depression?

  • The phenothiazine neuroleptics.

And what antihypertensive agents can sometimes cause depression?

  • Actually, just about all of the antihypertensive drugs can cause depression.

And what 2 types of metal poisoning are most strongly associated with depression?

  • Mercury and thallium.

What drugs sometimes used for treating peptic ulcer or GERD is also associated with the risk of causing depression?

  • Cimetidine.

And the trade name?

  • Tagamet.

And what type of agent is Cimetidine (trade name Tagamet)?

  • It is an H2 blocker.

What is the NSAID that is associated with the risk of causing depression?

  • Indomethacin.

And trade name?

  • Indocin.

And finally, what entire class of toxic drugs are strongly associated with depression?

  • All of the cytotoxic chemotherapeutic agents for the treatment of cancer.

What is the drug of choice for post-traumatic stress disorder?

  • I’m sorry, it’s a trick question- there is no single drug which is effective in treating all 3 parts of PTSD- Post Traumatic Stress Disorder.

What are these 3 parts?

  • Re-experiencing the trauma, hyper-arousal, or numbing and avoidance. All of the agents which have been tried, which include the tricyclic antidepressants, the monoamine oxidase inhibitors, the SSRIs, and even Naltrexone, the opiate antagonist, all of these appear to give only temporary and minor symptomatic relief.

What newer drug has recently been shown to be effective as an adjunct to psychosocial treatment for the treatment of alcoholism?

  • Naltrexone.

And the trade name for Naltrexone?

  • Revia.

In terms of its mechanism of action, what type of drug is Naltrexone/Revia?

  • It is an opioid antagonist.



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