Exam 5 - Lec 70 Bipolar Ott Flashcards
_______ is the mood pole that is experienced most often in bipolar disorder - can lead to misdiagnoses
depression
alcohol and substance abuse is common (___-___%) in bipolar disorder
50-60%
T or F: Anxiety disorders are common comorbidities and can significantly impact remission of mood episodes if left untreated or inadequately treated
T
bipolar I disorders requires at least ___ manic episdoes
1
bipolar II disorder includes major depressive and __________ episodes
hypomanic
T or F: lithium is associated with an increase in suicidality
F (dec)
T or F: lithium is a narrow therapeutic index (NTI) medication
T
what is the conversion for lithium liquid vs tablets/capsules?
1:1 conversion
acute lithium tx
a. 0.9-1.2 mEq/L
b. 0.6-0.9 mEq/L
c. 1.5 - > 3.0 mEq/L
a. 0.9-1.2 mEq/L
maintenance lithium tx
a. 0.9-1.2 mEq/L
b. 0.6-0.9 mEq/L
c. 1.5 - > 3.0 mEq/L
b. 0.6-0.9 mEq/L
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
c. 1.5 - > 3.0 mEq/L
we should draw trough serum lithium conc ___ hours after dose initiation, ___ hours after last dose
72; 12
look at slide 12 for lithium toxicities and SE
you got it
T or F: lithium is preferred in 1st trimester of pregnancy
F (avoid in 1st trimester - use with caution in 2nd and 3rd trimester)
what cardiac structure abnormality can lithium cause?
Ebstein’s anomaly
look at slide 13 for lithium lab monitoring
ok
lithium drug interactions: ACEi, ARBs, thiazides, NSAIDs, dehydration
a. dec Li renal clearance
b. inc Li renal clearance
c. inc Li excretion
a. dec Li renal clearance
lithium drug interactions: caffeine, osmotic diuretics, +/- loop diuretics
a. dec Li renal clearance
b. inc Li renal clearance
c. inc Li excretion
b. inc Li renal clearance
lithium drug interactions: sodium bicarb, high Na intake
a. dec Li renal clearance
b. inc Li renal clearance
c. inc Li excretion
c. inc Li excretion
lithium toxicity related to Na depletion is due to which diuretics?
a. thiazides
b. loops
c. osmotic
a. thiazides
ER valproate is ~___-___% less bioavailable than delayed release (DR) dosage form
10-15%
T or F: valproic acid syrup (IR) and capsule sprinkle form has higher risk for GI ulcerations (usually esophageal)
T
conversion for ER valproate and DR valproate
1:1; expect lower serum conc with the ER form - usually not clinically signif
valproate serum levels _____-_____ mcg/mL is associated with the most efficacy in mania
80-125
for valproate, serum levels should be obtained at least ___ hours after first dose or dose increase
96 (4 days)
T or F: valproate is used in 1st trimester, but shouldn’t be used 2nd or 3rd trimester
F (unsafe in any trimester, get baseline pregnancy test)
PCOS occurs in up to ___% of women on valproate
50%
look at slide 15 for AEs of valproate
sure
look at slide 16 for lab monitoring for valproate
okay
valproate and lamotrigine being used together will inc lamotrigine serum conc and increased risk of ?
Stevens-Johnson syndrome
carbamazepine is associated with
a. thrombocytopenia/hematologic effects
b. hyponatremia
c. heat intolerance
a. thrombocytopenia/hematologic effects
oxcarbazepine is associated with
a. thrombocytopenia/hematologic effects
b. hyponatremia
c. heat intolerance
b. hyponatremia
oxcarbazepine is a ___ inducer
3A4
which mood stabilizer is 1st line for depressive sx in bipolar disorder?
a. lamotrigine
b. topiramate
c. carbamazepine
d. oxcarbazepine
a. lamotrigine
T or F: lamotrigine is useful for acute tx or for manic disorders
F (not useful)
which mood stabilizer may cause weight loss, heat intolerance/hypohidrosis, metabolic acidosis, and kidney stones?
a. carbamazepine
b. oxcarbazepine
c. lamotrigine
d. topiramate
d. topiramate
which mood stabilizer is a POSSIBLE teratogen - cardiac structural defects?
a. carbamazepine
b. oxcarbazepine
c. lamotrigine
d. topiramate
d. topiramate
T or F: atypical antipsychotics may be used as monotherapy or can be used combination with other mood stabilizers (usually valproate or lithium)
T
T or F: pts on antipsychotics for bipolar disorder should be monitored for metabolic syndrome and movement SE
T
T or F: mood stabilizer tx is short-term and considered to be adjunct tx to reduce time to subsequent mood episodes
F (long-term, maintenance tx not adjunct)
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
b. lamotrigine
T or F: if using antidepressants in bipolar disorder, they need to be in combo with maintenance mood stabilizer therapy
T
we use __________ antidepressants to treat anxiety in bipolar disorder
a. dopaminergic
b. serotonergic
c. noradrenergic
b. serotonergic
4 mood stabilizers that target the depressive pole
lamotrigine
lithium
lurasidone
quetiapine
