Ch 33: Drugs for Bipolar Disorder

Question 1

Although the precise etiology of bipolar disorder (BPD) is unknown, it is clear that symptoms are caused by _______ _____ __________, not by a character flaw or unstable personality.

Answer 1

altered brain physiology

p. 364

Question 2

What are the 4 types of moods episodes people with BPD can experience?

Answer 2

pure mania, hypomania, major depressive, and mixed

p. 364

Question 3

In a true mixed episode, patients experience symptoms of…

Answer 3

…mania and depression simultaneously.

p. 364

Question 4

A single mood episode many last for…

Answer 4

…days, weeks, months, or more than a year.

p. 364

Question 5

How is Bipolar I Disorder defined?

Answer 5

Patients experience manic or mixed episodes, and usually depressive episodes too.

(p. 365)

Question 6

How is Bipolar II Disorder defined?

Answer 6

Patients experience hypomanic or depressive episodes, but not manic or mixed episodes.

(p. 365)

Question 7

Mood-stabilizing drugs can prevent or reverse neuronal atrophy in patients with BPD, apparently by influencing…

Answer 7

…signaling pathways that regulate neuronal growth and survival.

(p. 365)

Question 8

What are the 3 major groups of drugs used to treat BPD?

And one more frequently used class…

Answer 8

mood stabilizers
antipsychotics
antidepressants

benzodiazepines are frequently used for sedation

(p. 365)

Question 9

What are the 3 primary mood stabilizers used in BPD?

Answer 9

Lithium
Carbamazepine
Valproic acid

(p. 365)

Question 10

In patients with BPD, antidepressants are always…

Answer 10

…combined with a mood stabilizer because of the long-held belief that if used alone, antidepressants may cause a hypomanic or manic episode.

(p. 365)

Question 11

Among clinicians with experience in BPD, the antidepressants of choice are…

Answer 11

…bupropion, venlafaxine, and the SSRI’s.

p. 365

Question 12

What are the preferred drugs for acute management of of manic episodes?

Answer 12

lithium and valproate (valproate is preferred in most cases, the only exception is euphoric mania, for which lithium is the drug of choice)

(p. 365)

Question 13

Lithium excretion is _______ when levels of sodium are low. As a result, in the presence of low sodium…

Answer 13

reduced
…lithium can accumulate to toxic levels.

(p. 367)

Question 14

Lithium levels must be kept below ___ _____.
Once the desired therapeutic effect has been achieved, the dosage should be reduced to produce maintenance levels of ___ to _ _____.
Levels between ___ and ___ _____ are appropriate for acute therapy of manic episodes.

Answer 14

1. 5 mEq/L
2. 4 to 1 mEq/L
3. 8 and 1.4 mEq/L

(p. 367)

Question 15

NSAIDs can increase lithium levels by as much as ___. Interestingly, ______ and ________ do NOT increase lithium levels.

Answer 15

60%
aspirin and sulindac

(p. 368)

Question 16

Why can lithium not be administered in a single daily dose?

Answer 16

Because of its short half-life and low therapeutic index.

p. 369

Question 17

What are the 3 pros of using valproate vs. lithium?

Answer 17

Valproate works faster, has a higher therapeutic index, and a more desirable side effect profile.

(p. 369)

Question 18

What are the 2 pros of using lithium vs. valproate?

Answer 18

Lithium is better at reducing the risk of suicide, and is more effective at preventing relapses.

Question 19

Lithium is a simple ________ ion that carries a single ________ charge.

Answer 19

inorganic
positive

(p. 366)

Question 20

In adherent patients, the most common cause of lithium accumulation is…

Answer 20

…sodium depletion.

p. 367

Question 21

What therapy should be used when lithium levels exceed 2.5 mEq/L.

Answer 21

hemodialysis.

p. 367

Question 22

There are a number of adverse effects that occur despite therapeutic levels of lithium. _____________ effects are common but __________; these include nausea, diarrhea, bloating, and anorexia.

Answer 22

Gastrointestinal

transient

Question 23

Polyuria is another common side effect of lithium. What is the mechanism by which this occurs?

Answer 23

Lithium promotes polyuria by antagonizing the effects of antidiuretic hormone, including impaired sodium reabsorption.

(p. 368)

Question 24

What endocrine/electrolyte imbalance conditions can lithium cause?

Answer 24

goiter and hypothyroidism

(p. 368)

….Also, glycosuria, hypercalcemia (secondary to hyperparathyroidism, hyperglycemia, and hyperparathyroidism
[from Lexicomp]

Question 25

In patients with lithium-associated hypothyroidism, treatment with levothyroxine will _______ both goiter and hypothyroidism.

Answer 25

reverse

p. 368