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Psych Clerkship & Jeopardy > Jeopardy Mood Stabilizers > Flashcards

Jeopardy Mood Stabilizers Flashcards

1
Q

Lithium: Blood levels should be drawn about this many hours after the last dose

A

What is 12 hours? (Trough)

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2
Q

Lithium: For maintenance treatment of Bipolar disorder, lithium levels should generally be above this

A

What is 0.6-0.8 mEq/L?

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3
Q

Lithium:Before starting a young male patient on lithium, labs that should routinely be done are these

A

What is TSH & BUN/creatinine?

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4
Q

In lithium maintenance treatment, ideally these labs are done 1-2 times per year

A

What is lithium level, TSH, BUN/creatinine?

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5
Q

This lithium side effect can
be worsened by caffeine or
improved with propranolol
treatment

A

What is tremor? (resting or postural?)

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6
Q

Unlike any antidepressant or mood stabilizer, Lithium treatment decreases patient’s mortality
risk from this

A

What is suicide?

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7
Q

Lithium toxicity with a lithium level greater than 4.0 mEq/L is
treated with this

A

What is dialysis?

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8
Q

To confirm therapeutic levels after starting lithium or increasing the dose, a lithium level
should be done after this
number of days

A

What is 5 days? (Lithium half life = ?)

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9
Q

For patients taking lithium, renal impairment, sodium depletion, or dehydration all increase
the risk of this

A

What is lithium toxicity?

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10
Q

Divalproex Sodium (Depakote) exposure during the first trimester of pregnancy increases the risk this serious congenital anomaly

A

What is neural tube defect (spina bifida)?

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11
Q

Before starting a male patient
on Divalproex Sodium
(Depakote), these two
lab tests should be done

A

What are LFT’s & platelets?

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12
Q

If Divalproex Sodium (Depakote)

is added to the medication regimen of a patient who is taking Lamotrigine (Lamictal) this should be done.

A

What is decrease Lamotrigine dose by half?

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13
Q

Propranolol 2-3x’s per day may be used to treat this common side effect of divalproex (depakote)

A

What is tremor?

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14
Q

The age range of patients most at
risk for divalproex’s (depakote)
side effect of serious, possibly
fatal, hepatoxicity is this

A

What is under 2 years old ?

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15
Q

Patients on the generic form of valproic acid (depakene) are at greater risk of developing this side effect than those on the enteric coated divalproex (depakote)

A

What are GI side effects? (N/V/D, GI discomfort)

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16
Q 
Ironically, divalproex (depakote) 
is indicated as prophylaxis for 
this condition, which is also one 
of divalproex (depakote)’s 
common side effects
A

What is Headache? (indicated for migraine prophylaxis)

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17
Q 
For divalproex (depakote), while the trough level of the Immediate Release (IR) should be drawn 12 hrs after 
the last dose, the trough level of 
Extended Release (ER) should 
be drawn at this time
A

What is 18 hour after the last dose?
If IR-last dose 10pm, blood draw 10am
If ER-last dose 10pm, blood draw 4 pm

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18
Q

For a patient taking Divalproex Sodium (Depakote), taking aspirin increases the risk of this

A

What is decreased platelets? Thrombocytopenia

19
Q

Over the first few weeks of taking carbamazepine (tegretol) its t1/2
will decease to less than 50%of
its initial t1/2 due to this

A

What is auto-induction?

20
Q

Exposure of the fetus during the 1st trimester of pregnancy leads to an unacceptable risk of this

A

What is neural tube defect?

21
Q 
Carbamazepine (tegretol) has a 
black box warning for these two 
rare (~1/100,000 = 0.001%) 
but serious side effects on 
the hematopoietic system
A

What is agranulocytosis & aplastic anemia?

22
Q

This electrolyte may be abnormally low in patients who are taking carbamazepine (tegretol)

A

What is sodium?

23
Q

CYP: 3A4 2D6 2C9

Carbamazepine (Tegretol) is both 
a substrate & an inducer of this 
cytochrome p450 enzyme system 
which makes up ~55% of the 
cytochrome p450 enzymes
A

What is CYP 3A4?

24
Q

Carbamazepine (tegretol)’s drug-drug interaction with hormonal birth control increases the risk of this

A

What is pregnancy?

25
Q

Closely related structurally to carbamazepine (tegretol), this medication has far fewer side
effects but is not FDA
approved for treatment of
bipolar disorder

A

What is oxcarbamazepine (trileptal)?

26
Q

Patients who are getting long term treatment with divalproex (depakote) or carbamazepine (tegretol) need to have regular labs done to check their medication blood levels, platelets/blood count, and this

A

What is liver function test?

27
Q

To decrease the risk of birth defects,

a woman on carbemazepine (tegretol) who desires to become pregnant should also take this medication

A

What is folate?

28
Q

Patients who start taking lamotrigine (lamictal) have a this % risk of developing a benign rash

A

What is 10%?

29
Q

While the side effect of a benign rash is relatively common, the risk of a severe rash is about 0.3%, and the risk of this is about 0.02-0.1%

A

What is Steven’s Johnson Syndrome?

30
Q

The drug-drug interaction between lamotrigine (lamictal) & divalproex sodium (depakote) results in lamictal’s blood level
doing this

A

What is increasing? (doubles)

31
Q

Lamotrigine (lamictal), quetiapine (seroquel), lithium, olanzapine/fluoxetine (symbyax),
& latuda (lurasidone) all have this in
common regarding their usage in
the treatment of pts with bipolar disorder

A

What is FDA indication to treats bipolar depression

32
Q 
Lamotrigine (lamictal), lithium, 
quetiapine (seroquel), olanzapine (zyprexa) & aripiprazole (abilify) 
all have this in common regarding 
their usage in treatment of pts 
with bipolar disorder
A

What is FDA indication for use in maintenance treatment of bipolar disorder?

33
Q

Lithium, divalproex (depakote),
carbamazepine ER (tegretol ER)
quetiapine (seroquel), ziprasidone (geodon),
& asenapine (saphris) are FDA indicated to treat this phase of bipolar disorder
but lamotrigine (lamictal) is not

A

What is an acute manic episode?

34
Q

Lithium, divalproex (depakote), quetiapine (seroquel), & olanzapine (zyprexa) with regard to these two common side
effects are NOT side effects
of lamotrigine (lamictal)

A

What is weight gain and sedation?

35
Q

The common mechanism of action for the mood stabilizers carbamazepine (tegretol), divalproex (depakote), and lamotrigine (lamictal) is
blocking these

A

What is Sodium channels?

36
Q

This SGA has FDA indication to treat acute mania or for maintenance treatment of bipolar disorder, but of all the SGA’s it has the highest risk for weight gain, elevated lipids,
and diabetes

A

What is olanzapine (zyprexa)?

37
Q

This SGA has FDA indication to treat acute mania or for maintenance treatment of bipolar disorder, but must be taken with food or > 50% will not be absorbed
in the digestive tract

A

What is ziprasidone (geodon)?

38
Q

While this SGA has FDA indication to treat acute mania or for maintenance treatment of bipolar disorder, it has a particularly long half life of ~75 hours and takes nearly 2 weeks to reach steady state

A

What is aripiprazole (abilify)?

39
Q 
This SGA has FDA indication to treat 
acute mania or for maintenance 
treatment of bipolar disorder, but 
at high doses (> 6 mg) it acts more 
like a FGA and has a much higher 
rate of EPS side effects
A

What is risperidone (risperdal)?

40
Q

This SGA has FDA indication to treat acute mania & must be taken sublingually because if it is swallowed only ~5% will be bioavailable due to 1st pass liver metabolism

A

What is asenapine (saphris)?

41
Q

These 2 SGA’s, in addition to being FDA indicated to treat acute mania or for maintenance treatment of bipolar disorder, are the least likely of the SGA’s to cause weight gain or metabolic syndrome

A

What is ziprasidone (geodon) & aripiprazole (abilify)?

42
Q

This SGA is FDA indicated to treat acute mania or for maintenance treatment of bipolar disorder, but should not be used in patient’s with ECG’s that show an
QTc > 500 milliseconds

A

What is ziprasidone (geodon)?

43
Q

These three SGA’s are useful is FDA indicated for treating bipolar depression; two by themselves, the other in combination with fluoxetine (prozac)

A

What are quetiapine (seroquel), latuda (lurasidone) & olanzapine (zyprexa)?

44
Q

Risperidone (risperdal consta), paliperidone (invenga sustenna),
and these 2 SGA’s are available
in a long acting injectable form

A

What is aripiprazole (abilify maintena) & olanzapine (zyprexa relprevv)

Psych Clerkship & Jeopardy (5 decks)

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