Bipolar

Question 1

acute treatment

Answer 1

-immediate treatment in response to current mood episode

Question 2

maintenace treatment

Answer 2

-preventative treatments after stabilization of cute mood episode

Question 3

mood stabilizers

Answer 3

-anticonvulsants
-atypical antipsychotic
-lithium

Question 4

First line mono therapy for acute mania

Answer 4

-second gen antipsychotic(quetiapine preferred)
-lithium
-valproate

Question 5

second line for acute mania

Answer 5

switch to another SGA, lithium or valproate

Question 6

3rd line for acute mania

Answer 6

-use first line agents in combo therapy
-SGA + lithium or valproate
-lithium + valproate

Question 7

SGAs to avoid in acute mania

Answer 7

-lurasidone
-lumateperone
-brecpiprazole

Question 8

First line mono therapy for acute bipolar depression

Answer 8

-SGA: quetiapine or lurasidone

Question 9

2nd line treatment for acute bipolar depression

Answer 9

-switch to another SGA, or lithium + lamotrigine

Question 10

3rd line combo treatments for acute bipolar depression

Answer 10

-SGA+ lithium or lamotrigine
-lithium + lamotrigine
-adjunct antidepressant: not as a monotherapy

Question 11

medications for mixed episodes

Answer 11

-SGA

Question 12

rapid cycling

Answer 12

-use antipsychotics or valproate
-avoid antidepressants and lithium

Question 13

high risk of suicide

Answer 13

• consider lithium, ECT

Question 14

psychosis

Answer 14

-antipsychotics, ECT

Question 15

Anxiety

Answer 15

antiphsychotic, valproate

Question 16

Pregnancy

Answer 16

-antipsychotic, lamotrigine, ECT
-avoid lithium and valproate

Question 17

True or False: mania symptoms take longer to resolve than bipolar depression with medication.

Answer 17

False.
Mania: 3-4 weeks
Bipolar: 6-8 weeks

Question 18

True or false: lithium is associated with reduced suicide rates

Answer 18

true

Question 19

onset of lithium

Answer 19

-5-10 days for actute mania
-6-8 weeks for acute depression

Question 20

Lithium dosing

Answer 20

-When first starting, split dosing 2-3 times a day to avoid side effects
-titrate every 5-7 days based on lithium levels

Question 21

Lithium drug levels

Answer 21

0.8-1 mEq/L is normal
-draw trough 12 hours post dose
-levels should be checked within 5-7 days of initiation or dose change(steady state)

Question 22

Lithium ADEs

Answer 22

-polyuria and polydipsia
-hypothyroidism
-hypercalcemia
-reduced kidney function
-N/V
-Diarrhea
-fine hand tremor
-Somnolence
-ataxia
-cognitive impairment
-weight gain
-sexual side effects

Question 23

Lithium interactions

Answer 23

-100% renally eliminated so it is susceptible to interactions
-kidney impairment
-sodium depletion
-dehydration
-cardio disease
-volume depletion

Question 24

Lithium drug interactions

Answer 24

-thiazide diuretics: hydrochlorothiazide
-NSAIDs
-ACE-I: linsinopril
-ARBs: lorasrtan

Question 25

Lithium toxcitity mild-mod

Answer 25

-develops over several days
-drowsiness
-confusion
-course hand tremor
-ataxia
-dysarthria/slurred speech
-reappearance of GI symptoms

Question 26

Lithium toxicity mod-severe

Answer 26

-gradual or sudden onset
-muscle tremor
seizure
coma
-hyperreflexia
-cardio collapse
-death
-requires hospitilization

Question 27

lithium in pregnancy

Answer 27

-avoid in 1st trimester of pregnancy due to cardiac malformations
-may require higher lithium dose during pregnancy
-dose reduction following delivery

Question 28

Lithium monitoring

Answer 28

-check at baseline then annually
-renal function
-thyroid function
-CBC
-electrolytes
-pregnancy tests
-BMA
-ECG is CVD risk factors presents