Bipolar Disorder

Question 1

Which LAIs are approved for Bipolar Disorder?

Answer 1

4 Total:
Abilify Maintena
Abilify Asimtufii
Aristada NOT approved

Risperdal Consta
Rykindo

Question 2

Which first line treatment (mood stabilizer) is NOT FDA approved for acute mania in BP-I

Answer 2

Lamotrigine

Carbamazepine, lithium, and VPA are

Question 3

Which mood stabilizers are FDA approved for BD maintenance

Answer 3

Lithium and Lamotrigine
(Recall lamotrigine not used in acute mania)

Question 4

Which SGAs show poor coverage for acute depression in BP?

Answer 4

Aripiprazole
Ziprasidone

Question 5

Lithium Key Points

Answer 5

Excreted unchanged in urine. (CI in severe renal/cardiac disease) No hepatic metabolism/interactions
Kidney damage / nephrogenic diabetes insipidus (NDI) seen in a large portion of patients
May unmask Brugada Syndrome
Decreases suicide risk
Benign hand tremor - can treat with beta blocker (don’t have to D/C lithium)
Hypothyroidism risk
Slow onset of action
GI/CNS side effects
NSAIDs, ACEi, ARB (all 3 kidney), diuretics (thiazides included - can affect serum concentrations), caffeine (dec. serum concentration), and CCB (neurotoxicity)
NOT recommended in pregnancy

Question 6

FDA approved anticonvulsants in BPD

Answer 6

• Valproate
• Lamotrigine
• Carbamazepine ER (Equetro version only)

Question 7

Valproate / Divalproex / Valproic Acid

Answer 7

Anticonvulsant
Dose related GI, tremor (can give beta-blocker) and sedation (can give HS)
Rapid cycling/mixed states
ER formulations have decreased bioavailability
Thrombocytopenia - prolonged bleeding
Weight Gain
Can cause reversible alopecia
Hyperammonemia
Boxed Warning: Pancreatitis, Hepatotoxicity, Urea Disorders

Question 8

Carbamazepine key warnings

Answer 8

Asian: HLA-B 1502 (10 times risk SJS/TEN) - beware patients reporting rash on carbamazepine!
Neutropenia, leukopenia, hematologic disorders
Agranulocytosis
Can affect TSH (lithium also guilty of thyroid abnormalities)

Question 9

Which SGAs are NOT FDA approved for Bipolar Disorder?

Answer 9

5 agents
Brexpiprazole (Rexulti)
Clozapine (Clozaril, Fazaclo)
Iloperidone (Fanapt)
Paliperidone (Invega)
Pimavanserin (Nuplazid)

Question 10

Lamotrigine carries what serious adverse effect risk?

Answer 10

DRESS