Exam 5 - Lec 70 Bipolar Ott

Question 1

_______ is the mood pole that is experienced most often in bipolar disorder - can lead to misdiagnoses

Answer 1

depression

Question 2

alcohol and substance abuse is common (___-___%) in bipolar disorder

Answer 2

50-60%

Question 3

T or F: Anxiety disorders are common comorbidities and can significantly impact remission of mood episodes if left untreated or inadequately treated

Answer 3

T

Question 4

bipolar I disorders requires at least ___ manic episdoes

Answer 4

1

Question 5

bipolar II disorder includes major depressive and __________ episodes

Answer 5

hypomanic

Question 6

T or F: lithium is associated with an increase in suicidality

Answer 6

F (dec)

Question 7

T or F: lithium is a narrow therapeutic index (NTI) medication

Answer 7

T

Question 8

what is the conversion for lithium liquid vs tablets/capsules?

Answer 8

1:1 conversion

Question 9

acute lithium tx

a. 0.9-1.2 mEq/L
b. 0.6-0.9 mEq/L
c. 1.5 - > 3.0 mEq/L

Answer 9

a. 0.9-1.2 mEq/L

Question 10

maintenance lithium tx

a. 0.9-1.2 mEq/L
b. 0.6-0.9 mEq/L
c. 1.5 - > 3.0 mEq/L

Answer 10

b. 0.6-0.9 mEq/L

Question 11

lithium toxicity (mild to severe)

a. 0.9-1.2 mEq/L
b. 0.6-0.9 mEq/L
c. 1.5 - > 3.0 mEq/L

Answer 11

c. 1.5 - > 3.0 mEq/L

Question 12

we should draw trough serum lithium conc ___ hours after dose initiation, ___ hours after last dose

Answer 12

72; 12

Question 13

look at slide 12 for lithium toxicities and SE

Answer 13

you got it

Question 14

T or F: lithium is preferred in 1st trimester of pregnancy

Answer 14

F (avoid in 1st trimester - use with caution in 2nd and 3rd trimester)

Question 15

what cardiac structure abnormality can lithium cause?

Answer 15

Ebstein’s anomaly

Question 16

look at slide 13 for lithium lab monitoring

Answer 16

ok

Question 17

lithium drug interactions: ACEi, ARBs, thiazides, NSAIDs, dehydration

a. dec Li renal clearance
b. inc Li renal clearance
c. inc Li excretion

Answer 17

a. dec Li renal clearance

Question 18

lithium drug interactions: caffeine, osmotic diuretics, +/- loop diuretics

a. dec Li renal clearance
b. inc Li renal clearance
c. inc Li excretion

Answer 18

b. inc Li renal clearance

Question 19

lithium drug interactions: sodium bicarb, high Na intake

a. dec Li renal clearance
b. inc Li renal clearance
c. inc Li excretion

Answer 19

c. inc Li excretion

Question 20

lithium toxicity related to Na depletion is due to which diuretics?

a. thiazides
b. loops
c. osmotic

Answer 20

a. thiazides

Question 21

ER valproate is ~___-___% less bioavailable than delayed release (DR) dosage form

Answer 21

10-15%

Question 22

T or F: valproic acid syrup (IR) and capsule sprinkle form has higher risk for GI ulcerations (usually esophageal)

Answer 22

T

Question 23

conversion for ER valproate and DR valproate

Answer 23

1:1; expect lower serum conc with the ER form - usually not clinically signif

Question 24

valproate serum levels _____-_____ mcg/mL is associated with the most efficacy in mania

Answer 24

80-125

Question 25

for valproate, serum levels should be obtained at least ___ hours after first dose or dose increase

Answer 25

96 (4 days)

Question 26

T or F: valproate is used in 1st trimester, but shouldn't be used 2nd or 3rd trimester

Answer 26

F (unsafe in any trimester, get baseline pregnancy test)

Question 27

PCOS occurs in up to ___% of women on valproate

Answer 27

50%

Question 28

look at slide 15 for AEs of valproate

Answer 28

sure

Question 29

look at slide 16 for lab monitoring for valproate

Answer 29

okay

Question 30

valproate and lamotrigine being used together will inc lamotrigine serum conc and increased risk of ?

Answer 30

Stevens-Johnson syndrome

Question 31

carbamazepine is associated with a. thrombocytopenia/hematologic effects b. hyponatremia c. heat intolerance

Answer 31

a. thrombocytopenia/hematologic effects

Question 32

oxcarbazepine is associated with a. thrombocytopenia/hematologic effects b. hyponatremia c. heat intolerance

Answer 32

b. hyponatremia

Question 33

oxcarbazepine is a ___ inducer

Answer 33

3A4

Question 34

which mood stabilizer is 1st line for depressive sx in bipolar disorder? a. lamotrigine b. topiramate c. carbamazepine d. oxcarbazepine

Answer 34

a. lamotrigine

Question 35

T or F: lamotrigine is useful for acute tx or for manic disorders

Answer 35

F (not useful)

Question 36

which mood stabilizer may cause weight loss, heat intolerance/hypohidrosis, metabolic acidosis, and kidney stones? a. carbamazepine b. oxcarbazepine c. lamotrigine d. topiramate

Answer 36

d. topiramate

Question 37

which mood stabilizer is a POSSIBLE teratogen - cardiac structural defects? a. carbamazepine b. oxcarbazepine c. lamotrigine d. topiramate

Answer 37

d. topiramate

Question 38

T or F: atypical antipsychotics may be used as monotherapy or can be used combination with other mood stabilizers (usually valproate or lithium)

Answer 38

T

Question 39

T or F: pts on antipsychotics for bipolar disorder should be monitored for metabolic syndrome and movement SE

Answer 39

T

Question 40

T or F: mood stabilizer tx is short-term and considered to be adjunct tx to reduce time to subsequent mood episodes

Answer 40

F (long-term, maintenance tx not adjunct)

Question 41

which of the following is not one of the 4 known or possible teratogens for bipolar? a. lithium b. lamotrigine c. valproate d. carbamazepine e. topiramate

Answer 41

b. lamotrigine

Question 42

T or F: if using antidepressants in bipolar disorder, they need to be in combo with maintenance mood stabilizer therapy

Answer 42

T

Question 43

we use __________ antidepressants to treat anxiety in bipolar disorder a. dopaminergic b. serotonergic c. noradrenergic

Answer 43

b. serotonergic

Question 44

4 mood stabilizers that target the depressive pole

Answer 44

lamotrigine lithium lurasidone quetiapine