bipolar disorder

Question 1

bipolar I

Answer 1

one episode of mania
mania only in bipolar I

Question 2

mania

Answer 2

one of the following :
impairment in social/work functioning
psychosis/delusions
require hospitalization

Question 3

polar II

Answer 3

atleast one episode of hypomania(4 days) and atleast one depressing episode >2 weeks

Question 4

hypomania

Answer 4

does not affect social /work functioning
does not cause psychosis nor require hospitalization

Question 5

bipolar depression

Answer 5

depressive eepisode symptoms and/or loss of interest perviously enjoyed

Question 6

psychosis

Answer 6

hallucination and delusions

Question 7

diagonosis

Answer 7

DSM5

Question 8

tx

Answer 8

1st line lithium (lamotrigine can be used as well) and antiepileptic drrugs
antidepressants can cause mania so should not be used mono therapy but with a mood stabilizer

Question 9

antidepressants

Answer 9

require med guides

Question 10

pregnancy and antipsychotics

Answer 10

avoid valproate, carbanmazepine, lithium in the first trimester if possible fetal cognitive effects
lamotrigine and lurasidone are safer

Question 11

antiepileptics used in bipolar

Answer 11

lamotrigine slow titration for skin rash
valproate
carbamazepine

Question 12

2nd gen antipsych

Answer 12

1st gen cause EPS
aripiprazole
olanzapine
quetiapine
risperidone
ziprasidone
Other
lurasidone
olanzapine/fluoxetine

Question 13

lithium

Answer 13

lithobid
MOA- reuptake of serotonin and/or NE
moderates glutamate- high levels can cause mania

Question 14

what is the therapeutic range for lithium

Answer 14

0.6-1.2

Question 15

what are the range AE with lithium

Answer 15

> 1.5 ataxia (cordination, balance), vomiting, tremor
2.5 CNS depression, arrythmia, seizure, coma

Question 16

any renal dose for lithium

Answer 16

no CYP3450 interactions
avoid in pregnancy

Question 17

what can increase lithium dose

Answer 17

less salt intake, sodium loss, ace diuretics NSAIDS

Question 18

what can decrease lithium dose

Answer 18

increase in salt intake, caffiene and theophylline

Question 19

what is a major risk of lithioum

Answer 19

serotonin syndrome

Question 20

what increases lithium to have more risk of serotonin syndrome

Answer 20

SSRI, SNRI, triptans, linezolid and other serotonic drugs

Question 21

lithium cirtate 5ml equals lithium conversions

Answer 21

8meq lithium ions

Question 22

8 meq lithium ion equals

Answer 22

300mg lithium carbonate

Question 23

lithium counselling

Answer 23

with food
maintain salt intake
hydration
non caffiene
pregnancy and breastfeeding care

Question 24

ae of lithium

Answer 24

GI upset
cognitive effects
cogwheel rigidity
thirst
polyuria
weight gain
hypothyroidism
polyuria