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AED/Lithium Flashcards

1
Q

Clinically significant increase in lamotrigine concentration may occur if co-administered with: (8x)

A

VALPROIC ACID

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2
Q

Teratogenic effect of both VPA and carbamazepine: (3x)

A

NEURAL TUBE DEFECTS

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3
Q

Carbamazepine should be D/C’ed if the absolute neutrophil count is below: (2x)

A

3,000

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4
Q

Pt w/ treatment-resistant mania and h/o rapid cycling is being treated w/ carbamazepine and thyroxine. After adding clozapine the pt is clinically stabilized. The pt’s most recent WBC is below 3,000. Intervention? (2x)

A

D/C CARBAMAZEPINE

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5
Q

Which of the following anticonvulsants may be associated with kidney stones? (2x)

A

TOPIRAMATE

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6
Q

Pt with treatment resistant, rapid cycling bipolar disorder who recently started lamotrigine develops a rash on the face. Pt admits to a mild sore throat and thinks he may have a fever. Which of the following is the best recommendation for the psychiatrist to make to the pt? (2x)

A

DISCONTINUE LAMOTRIGINE AND COME TO THE APPROPRIATE ER

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7
Q

Which med decreases the efficacy of oral contraceptive? (2x)

A

OXCARBAZEPINE

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8
Q

Drug prophylactic for treatment of migraines: (2x)

A

VALPROATE AND TOPIRAMATE

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9
Q

Interaction between valproic acid and lamotrigine that causes severe derm reactions?

A

VALPROIC ACID INHIBITS GLUCONURONIDATION

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10
Q

Associated with neural tube defect in first trimester of pregnancy:

A

VALPROATE

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11
Q

Which of the following meds is associated with benign maculopapular rash in approximately 10-15% of pt’s within the first 3 weeks of treatment?

A

CARBAMAZEPINE

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12
Q

After psychiatrist adds new med, pt turns bright red w/ sunburn like rash, similar to SJS. Which med caused this?

A

LAMOTRIGINE

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13
Q

Inducer and substrate of CYP3a4 (ie may require dose increase after several weeks to maintain steady state)

A

CARBAMAZEPINE

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14
Q

Lancinating face pain, triggered by minor sensory stimuli, best treated initially with:

A

CARBAMAZEPINE

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15
Q

Which drug used in the treatment of patients with epilepsy is assoc w hyponatremia?

A

CARBAMAZEPINE

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16
Q

Coarsening of facial features and hirsuitism are SE of what med?

A

VALPROATE

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17
Q

Acute onset of hematuria and lumbago? Side effect of which anticonvulsant?

A

TOPIRAMATE

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18
Q

Pt taking carbamazepine for BMD presents with weakness and pallor. The psychiatrist notes the presence of a non-blanching rash on the patient’s arms. The most immediate lab test to order is:

A

CBC

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19
Q

Lamotrigine is effective treatment for what mood disorder?

A

BIPOLAR DEPRESSION

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20
Q

Fetal exposure to valproate during pregnancy increases risk of:

A

NEURAL TUBE DEFECTS

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21
Q

8 y/o Dx w/ Bipolar d/o is about to start valproic acid. What needs to be monitored frequently?

A

LIVER FUNCTION

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22
Q

Which antibiotic may significantly raise carbamazepine levels and precipitate heart block?

A

ERYTHROMYCIN

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23
Q

What justifies using Valproate more commonly that lithium for BMD in pts > age 65?

A

CHANGES IN RENAL CLEARANCE MAKES LITHIUM DOSING PROBLEMATIC

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24
Q

Side effect more frequent in carbamazepine than lithium:

A

DIZZINESS

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25
Q

Hair loss + weight gain are SE of which anticonvulsant:

A

DIVALPROEX SODIUM

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26
Q

Which of the following baseline labs should be obtained for pt being treated with valproate?

A

LIVER FUNCTION TESTS

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27
Q

What CBC value is most important to follow when on Depakote?

A

PLATELETS

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28
Q

What is the most common reason pts discontinue valproate?

A

WEIGHT GAIN

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29
Q

Adequate as a monotherapy for juvenile myoclonic epilepsy:

A

VALPROATE

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30
Q

Adequate for monotherapy generalized tonic clonic szs:

A

VALPROATE

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31
Q

Of these meds (topiramate, lamotrigine, valproic acid, levetiracetam, Oxcarbazepine), which is most likely to be free of any significant interaction with other antiepileptic medications?

A

LEVETIRACETAM

32
Q

Valproate’s epigenetic modifying properties due to effect on ?

A

HISTONE DE-ACETYLASE

33
Q

Treatment of choice for lithium intoxication who manifests impaired consciousness, neuromuscular irritability, and seizures is (10x)

A

HEMODIALYSIS

34
Q

Which med is thought to have a protective effect independent of its mood- stabilizing effect against suicide risk in pts w mood disorder? (4x)

35
Q

Psoriasis exacerbated by: (3x)

36
Q

32 y/o F pt w/ BMD has been treated with lithium. Pt reveals to her psychiatrist that she is now pregnant. Attempts to dc lithium in the past have led to relapses of the pt’s disorder, with severe associated morbidity. A trial of an antipsychotic in the past resulted in NMS, and pt has since refused to use them. Which of the following would be the best option for treatment during the pregnancy? (3x)

A

CONTINUE LITHIUM

37
Q

A pt who was previously stable on Lithium presents with symptoms of toxicity after their PMD starts them on a HTN medicine. Which of the following is the is the most likely mechanism of interaction between the lithium and the HTN medication (X3)?

A

REDUCED RENAL CLEARANCE

38
Q

What lab test should be conducted prior to initiation of lithium tx (x3)?

39
Q

A 32 yo F comes to the ED with CC of 2 weeks of diarrhea. On exam she is anxious and tremulous and is not oriented to date or time of the day. She states she is taking “some drug” for Bipolar disorder and adds that she started doubling her dose a month ago because she “wasn’t getting better fast enough.” She denies use of drugs/ETOH. Which medication would most likely cause the symptoms described? (x2)

40
Q

62 y/o F w bipolar d/o develops altered mental status, dysarthria, ataxia in hosp after meds are added in hospital to her lithium. What medication could cause this? (2x)

A

INDOMETHACIN COMPETES WITH LITHIUM FOR EXCRETION AND CAUSES LITHIUM TOXICITY SYMPTOMS

41
Q

Lithium exposure in first trimester of pregnancy increases risk of congenital abnormalities in which organ? (2x)

42
Q

Lithium can be removed via hemodialysis because? (2x)

A

HAS NO METABOLITES

43
Q

Stable, steady state Lithium levels are generally obtained within: (2x)

44
Q

Which of the following factors is a predictor of a poor response to lithium? (2x)

A

RAPID CYCLING

45
Q

What factor is thought to predict a poor response to lithium treatment for pts with bipolar disorder? (2x)

A

MIXED MANIC/DEPRESSED EPISODE

46
Q

Giving charcoal is an ineffective treatment for pt who OD’d on (x2):

47
Q

Which of the following medications was first used as a treatment for gout and later promoted by john cade for treatment of unstable mood? (X2)

48
Q

What can decrease Li levels

49
Q

Li induced polyuria tx with least effect on Li level?

50
Q

Bipolar pt on lithium and Zoloft for 3 yrs. Level 0.8. More depressed and fatigued, low energy level. Increasing Zoloft ineffective. Next step:

A

OBTAIN TSH LEVEL

51
Q

This cardiovascular disturbance is most common for Lithium:

A

BENIGN T WAVE CHANGES.

52
Q

Medication most likely to cause cognitive side effects, even seizures, if taken at same time as ECT?

53
Q

A psychotropic with same pharmacokinetic properties in Asian Americans and White Americans

54
Q

Lithium serum levels should be monitored by evaluating:

A

TROUGH LEVELS 12 HOURS AFTER LAST DOSE

55
Q

Which med can decreased serum concentration of lithium

A

AMINOPHYLLINE

56
Q

BMD Tx with Li x 2 years develops rapid cycling. What lab test should be done?

A

THYROID FUNCTION TESTS

57
Q

SE of toxic serum lithium levels

A

ST DEPRESSION, QTC PROLONGATION, ATAXIA, TREMOR, DYSARTHRIA, NEPHROTOXIC SX, STATUS EPILEPTICUS

58
Q

24 y/o F in 2nd trimester now manic w/ no psychotic fx’s. Hx of 1 episode of mania, diagnosed bipolar I. D/C lithium when she decided to have kids. Willing to begin Tx.

A

RESTART LITHIUM

59
Q

The most common cause of severe polyuria with lithium is:

A

NEPHROGENIC DIABETES INSIPIDUS

60
Q

While taking lithium patients should:

A

MAINTAIN SODIUM INTAKE

61
Q

A CNS structure that is likely to suffer permanent damage following lithium toxicity:

A

CEREBELLUM

62
Q

Interferes w/ clearance of lithium

63
Q

Cardiac effects of lithium resemble what on EKG

A

HYPOKALEMIA (LOW T WAVES)

64
Q

Predictor of positive response to lithium prophylaxis:

A

HISTORY OF GOOD INTER-EPISODE FUNCTION

65
Q

In patients on lithium, what type of thyroid dysfunction can occur?

A

HIGH PREVALENCE OF THE PRODUCTION OF THYROID AUTOANTIBODIES

66
Q

Intake of this increases lithium levels

A

FLUOXETINE

67
Q

Which of the following laboratory tests is essential prior to prescribing lithium?

A

BUN AND CREATININE

68
Q

55 y/o pt with guilt, anhedonia, insomnia, and sad mood has been treated for 10 wks with fluoxetine 60mg qam. His mood and appetite have improved, though he still has difficulties with concentration, hopelessness, and tearfulness. He denies a h/o manic or psychotic symptoms. The medication most likely to augment the antidepressant effect of his current regimen would be:

69
Q

Pt on lithium and paxil. Lithium is ineffective despite a therapeutic level. What do you do?

A

DISCONTINUE PAXIL

70
Q

Which nervous system structure is likely to suffer permanent damage from lithium OD?

A

CEREBELLUM

71
Q

Lithium can raise what serum electrolyte?

72
Q

Tx of acute mania w/ lithium. What is the best adjunctive agent?

73
Q

Characteristic that makes lithium readily dialyzable:

A

LOW MOLECULAR WEIGHT

74
Q

When used at a therapeutic dose during pregnancy, the dose of which medicine should be reduced in the postpartum period to minimize ASE’s? Lithium, Lamotrigine, Carbamazepine, Topiramate, Valproate

75
Q

What is a pharmacological effect of lithium?

A

GLYCOGEN SYNTHASE KINASE-3 INHIBITION

PRITE-Tx (13 decks)

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