Bipolar Disorder

Question 1

BP is classified as BP I and BP II, which differ primary by what?

Answer 1

the severity of mania

Question 2

At least one episode of mania, and usually, bouts of intense depression (a depressive episode is not required for diagnosis)

Answer 2

Bipolar I

mania is associated with at least one of the following: significant impact in social or work functioning, psychosis or delusions or requires hospitalizations

Question 3

At last one episode of hypomania (lasting >4 consecutive days) and at least one depressive episode last >2 weeks

Answer 3

Bipolar II

hypomania does NOT affect social or work functioning, does not cause psychosis nor hospitalization

Question 4

How is mania diagnosed?

Answer 4

exhibits >3 symptoms

• inflated self-esteem
• needs less sleep
• more talkative than normal
• topic jumping
• easily distracted
• goal-directed activity inc
• high-risk pleasure activities

Question 5

What are the traditional mood stabilizers that treat both mania and depression?

Answer 5

lithium, valproate, lamotrigine, carbamazepine

Question 6

These drugs can help stabilize the mood when mania occurs with psychosis

Answer 6

antipsychotics

Question 7

these drugs can induce or exacerbate a mania episode when used as monotherapy, so they should only be used in combination with a mood stabilizer

Answer 7

antidepressants

Question 8

What is the acute treatment for a manic episode?

Answer 8

first line: valproate, lithium or an antipsychotic

severe: antipsychotic+ (lithium or valproate)

Question 9

Acute treatment for a depressive episode?

Answer 9

First line: lithium

alt: lamotrigine

Question 10

Maintenance treatment?

Answer 10

should be initiated after the acute episode

lithium and valproate are preferred for maintenance monotherapy

alt: lamotrigine, carbamazepine, SGAs

Question 11

What is required with all antidepressants and with all antipsychotics

Answer 11

medguides

Question 12

Valproate

carbamazepine

and lithium in preg can cause

Answer 12

cognitive effects.

AVOID, esp in 1st trimester

Question 13

What is the safer option in pregnancy?

Answer 13

lamotrigine.

Lurasidone has the most favorable safety profile in preg, but its use is limited for dipolar depression

Question 14

Lamotrigine should not be used for

Answer 14

acute mania

slow titration

Question 15

Lamictal

Answer 15

lamotrigine

Question 16

Depakote, Depacon, Depakene

Answer 16

Valproate/Valproic acid

Question 17

Equetro

Answer 17

Carbamazepine

Question 18

What is the major concern with antipsychotics?

Answer 18

EPS

first-generation has a higher incidence than SGAs

Question 19

What are the more common SGAs that can be used alone or in combo with mood stabilizers for acute mania and or maintenance treatment

Answer 19

Abilify
Zyprexa
Seroquel
Risperdal
Geodon

Question 20

Brand: abilify

Answer 20

Generic: aripiprazole

Question 21

Brand: Zyprexa

Answer 21

Generic: Olanzapine

Question 22

Brand: Seroquel

Answer 22

Generic: Quetiapine

Question 23

Grand: Risperdal

Answer 23

Generic: Risperdone

Question 24

Brand: Geodon

Answer 24

Ziprasidone

Question 25

This drug can be used alone or in combo with mood stabilizer for bipolar depressive episodes

Answer 25

lurasidone/latuda

Question 26

Brand: Latuda

Answer 26

Generic: lurasidone

Question 27

This drug works by influencing the reuptake of serotonin and or NE or by moderating glutamate levels in the brain

Answer 27

Lithium (Lithobid)

could cause serotonin syndrome

Question 28

What is the therapeutic range of lithium?

Answer 28

0.6-1.2mEq/L trough

Question 29

This drug side effect profile:

GI upset, cognitive effects, cogwheel rigidity, hand tremor, thirst/polyuria/polydipsia, weight gain, hypothyyoidism

Answer 29

Lithium

Question 30

Lithium toxicity level >1.5 could cause

Answer 30

ataxia, course hand tremor, vomiting

Question 31

Lithium toxicity level >2.5 could cause

Answer 31

CNS depression, arrhythmia, seizure, coma

Question 32

Lithium monitoring:

Answer 32

lithium levels, renal, thyroid function

Question 33

This drug has drug interactions with:

INC drug:
sodium loss (ACE/ARBs)
NSAIDs

DEC drug:
inc salt intake, caffeine

Answer 33

Lithium

Question 34

5mL of lithium citrate syrup = ___ mEq of lithium ion

Answer 34

8mEq

Question 35

8mEq of lithium ion = ___mg of lithium carbonate

Answer 35

300mg