Bipolar Disorder Flashcards
Which of the following statements best describes the primary difference between bipolar I and bipolar II?
a. Psychotic episodes occur more often in bipolar II
b. Hypomanic episodes cause more significant impairment in social functioning in bipolar II
c. Depressive episodes are more severe in bipolar I
d. Mania can require hospitalization in bipolar II
e. Manic episodes are more severe in bipolar I
e
The presence of at least 1 manic episodes distinguishes bipolar I from bipolar II. Mania only occurs in bipolar I, but hypomania and depressive episodes can occur in bipolar I and II.
SK is a 28 y/o male currently taking 10 mL of lithium citrate syrup PO TID for bipolar disorder. He would like to switch to lithium carbonate tablets or capsules. How many mg of lithium carbonate will he need to take for each dose?
a. 300 mg
b. 450 mg
c. 600 mg
d. 750 mg
e. 900 mg
c
5 mL lithium = 8 mEq lithium
8 mEq lithium = 300 mg lithium
JN is a 43 y/o black female with bipolar disorder who presents to the clinic for her regular check-up. Her current med list includes lithium carbonate, B-vitamin “energy” complex, acetaminophen, quetiapine, ibuprofen, amlodipine, and Flonase. Which of JN’s meds can increase her lithium level?
a. Acetaminophen
b. Amlodipine
c. Flonase
d. Ibuprofen
e. Quetiapine
d
NSAIDs such as ibuprofen can increase lithium levels, which could cause toxicity. If an NSAID must be used with lithium, aspirin and sulindac are considered safer options.
Which of the following side effects can occur with lithium?
a. Constipation
b. Increased LDL
c. Thirst
d. Neutropenia
e. Weight gain
c, e
A fine hand tremor can occur at normal levels, in addition to nausea, weight gain, or anorexia.
Which resource should be consulted to find diagnostic criteria for psychiatric disorders?
a. The Brain and Behavior Research Foundation
b. The American Psychiatric Association (APA) Handbook
c. The Handbook of Community Psychiatry
d. The Diagnostic and Statistical Manual of Mental Disorders
e. The Joint National Committee on Psychiatric Illness
d
A 42 y/o male is admitted for an episode of acute mania. He wasn’t previously diagnosed with bipolar disorder and doesn’t currently take any meds. Which med is the most appropriate to start at this time?
a. Lamotrigine
b. Olanzapine + fluoxetine
c. Latuda
d. Citalopram
e. Depakote
e
-Lithium and valproate (Depakote) are preferred to treat an episode of acute mania.
-Lamotrigine is only used for acute depression or maintenance tx.
-Latuda and Symbyax (olanzapine + fluoxetine) are only used for bipolar depression.
Which of the following meds increases the risk of serotonin syndrome when taken with lithium?
a. Chlorthalidone
b. Linezolid
c. Phenytoin
d. Theophylline
e. Valsartan
b
Serotonergic drugs (e.g., linezolid, SSRIs, SNRIs, triptans, and others) should be used cautiously with lithium d/t the additive risk of serotonin syndrome.
HL is a 50 y/o female who’s starting lithium as a mood stabilizer for bipolar disorder. Which of the following labs should be monitored?
a. AST and ALT
b. Triglycerides and LDL
c. BUN and SCr
d. TSH and FT4
e. Amylase and lipase
c, d
A pharmacist is educating a pt on his new Rx for Lithobid. Which of the following side effects should the pt be counseled on?
a. Constipation
b. Bleeding risk
c. Hirsutism
d. Increased urination
e. Thrombocytopenia
c
Chronic lithium tx can decrease the kidney’s ability to concentrate urine, leading to an increase in urination and thirst.
What is the desired trough level for a pt taking lithium?
a. 0.5-0.9 ng/L
b. 1.5-2.5 mEq/L
c. 1-2.5 mcg/mL
d. 0.6-1.2 mEq/L
e. 4-12 mcg/L
d
at least 1 episode of mania, and usually bouts of intense depression (a depressive episode isn’t required for diagnosis)
bipolar I
Associated with at least 1 of the following: Significant impairment of in social/work functioning, psychosis/delusions, or requires hospitalization
mania
At least 1 episode of hypomania and at least 1 depressive episode
bipolar II
Doesn’t affect social/work functioning, doesn’t cause psychosis, nor require hospitalization
hypomania
How is mania diagnosed?
Patient exhibits 3 or more of the symptoms of mania, or if their mood is only irritable, they exhibit 4 or more symptoms
Definition of mania: Abnormally elevated or irritable mood for at least ________ (or any duration if ________________ is needed).
1 week; hospitalization
Goal of treatment for bipolar disorder
stabilize the mood without inducing a depressive or manic state
The traditional mood stabilizers that treat both mania and depression include what?
lithium and antiepileptics (valproate, lamotrigine, and carbamazepine)
Help stabilize mood when mania occurs with psychosis
antipsychotics
Can induce or exacerbate a manic episode when used as monotherapy, so they should only be used in combo with a mood stabilizer
antidepressants
1st line treatment for manic episodes
valproate, lithium, or an antipsychotic
1st line treatment for depressive episodes
antipsychotic
Add on therapies or alternatives to depressive episodes
lithium, valproate, or lamotrigine
Match the therapies for bipolar disorder with its correct teratogenic effect:
- Valproate
- Carbamazepine
- Lithium
a. Increase in congenital cardiac malformations
b. Facial abnormalities
c. Neural tube defects and long-term adverse cognitive effects
- c
- b
- a
Which drug is a safer option than other bipolar medications and can be used in pregnancy?
lamotrigine
Has the most favorable safety profile in pregnancy, but its use is limited since it is only approved for bipolar depression
lurasidone
Therapeutic range for lithium
0.6-1.2 mEq/L (trough level)
Match the adverse events with its correct serum lithium level:
- GI upset, cognitive effects, cogwheel rigidity, tremor, thirst, polyuria/polydipsia, weight gain, hypothyroidism
- Ataxia, coarse hand tremor, vomiting
- CNS depression, arrhythmia, seizure, coma
a. > 2.5 mEq/L
b. 0.6-1.2 mEq/L (within therapeutic range)
c. > 1.5 mEq/L
- b
- c
- a
Decreased salt intake, sodium loss with ACE inhibitors and ARBs, and NSAIDs ________ lithium levels.
increase
Increased salt intake ___________ lithium levels.
decreases
5 mL lithium citrate syrup = __ mEq of lithium ion
8
8 mEq/L of lithium ion = ___ mg lithium carbonate tabs/caps
300
