Ch 33 Bipolar Meds

Question 1

BPD is treated with three kinds of drugs:

Answer 1

mood stabilizers,
antipsychotic drugs, and
antidepressants

Question 2

Mood stabilizers are drugs that (3)

Answer 2

(1) relieve symptoms during manic and depressive episodes;
(2) prevent recurrence of manic and depressive episodes; and
(3) do not worsen symptoms of mania or depression and do not accelerate the rate of cycling.

Question 3

Antipsychotic drugs are used acutely to __, and long term to __. Benefits occur in patients with and without psychotic symptoms.

Answer 3

treat manic episodes

help stabilize mood

Question 4

In patients with bipolar depression, using an antidepressant alone may induce __.

Answer 4

mania—although the risk appears lower than previously believed.

Nonetheless, to minimize risk of mania, antidepressants should not be routinely used alone; rather, they should be combined with a mood stabilizing drug.

Question 5

(2) are the preferred mood stabilizers for BPD.

Answer 5

Lithium and valproate

Question 6

To minimize the risk of toxicity, lithium levels must be

monitored. The trough level, measured ___, should be less than 1.5 mEq/L.

Answer 6

12 hours after the evening dose

Question 7

Common side effects that occur at therapeutic lithium levels include (3).

Answer 7

tremor, goiter, and polyuria

Question 8

Lithium may be ___.

Answer 8

teratogenic, and hence should be avoided during the first trimester of pregnancy.

Also, unless the benefits outweigh the risks, lithium should be avoided during the second and third trimesters too.

Question 9

A reduction in __ will reduce lithium excretion,

causing lithium to accumulate—possibly to toxic levels.

Answer 9

sodium levels

Patients must maintain normal sodium intake and levels.

Question 10

Lithium levels can be increased by (2).

Answer 10

diuretics (especially thiazides) and by several nonsteroidal anti-inflammatory drugs