Module 4 - Mood Disorders

Question 1

Time it takes for lithium to reach peak levels

Answer 1

1-1.5 hours

4-5 hours with controlled release

Question 2

Time it takes for lithium to reach equilibrium

Answer 2

5-7 days

Question 3

half life of lithium

Answer 3

18-24 hours

shorter in children, longer in older adults

Question 4

Controls acute manic episodes

takes 1-3 weeks for full effects of antimania

Answer 4

Lithium

Question 5

Best course when depression occurs while patient is on maintenance lithium

Answer 5

Increase concentration to 1-1.2 mEq. OR
Add Cytomel (thyroid hormone)

Question 6

Drugs that increase concentrations of lithium

Answer 6

NSAIDs
Thiazide diuretics
ACE Inhibitors
Metronidazole

Question 7

mild to moderate signs of lithium toxicity

1.5-2.0 mEq/L

Answer 7

vomiting
abdominal pain
ataxia, dizziness, slurred speech, nystagmus, muscle weakness

Question 8

Moderate to severe signs of lithium toxicity

2.0-2.5 mEq/L

Answer 8

Anorexia, persistent N/V

Blurred vision, clonic limb movements, hyperactive deep tendon reflexes, convulsions, delirium coma, stupor

Question 9

Severe signs of lithium toxicity

>2.5 mEq/L

Answer 9

convulsions, oliguria, renal failure, death

Question 10

When to take lithium levels

Answer 10

12 hours after last dose

Question 11

Therapeutic level of Depakote

Answer 11

50-100 mmol/L

Question 12

Half life of Depakote

Answer 12

10-16 hours

Question 13

Average length of response to Depakote for acute mania

Answer 13

5 days

Question 14

Useful to decrease agitation and impulsivity

Answer 14

Depakote

Question 15

Side effects of. Depakote

Answer 15

GI irritation, nausea, sedation, tremor, weight gain, hair loss, can decrease Ca+ and VD

Question 16

rare but serious side effect of Depakote

Answer 16

Platelet dysfunction, agranulocytosis

check CBC

Question 17

Usual dose range of Depakote for acute mania

Answer 17

1200-1500 mg/day

Question 18

Labs to check before starting Depakote

Answer 18

hepatic panel, CBC with platelet counts, pregnancy test,

Question 19

Labs to monitor every 6 months or so while on Depakote

Answer 19

LFTs, VPA level, platelets

Monitor for metabolic syndrome

Question 20

FDA approved for maintenance of bipolar-1

Answer 20

Lamotrigine (Lamictal)

Lithium

Question 21

half life of lamictal

Answer 21

25 hours

Question 22

severe effect of Lamictal

Answer 22

Steven Johonson syndrome

Question 23

Lamictal and Depakote together

Answer 23

Depakote doubles Lamictal serum concentrations

Question 24

normal dosing of lamictal

Answer 24

25 mg QD for 2 weeks
50 mg QD for 2 weeks……
Up to 200 mg/day

Question 25

dosing of lamictal with depakote

Answer 25

25 mg every other day for two weeks

up to 100 mg/day

Question 26

dosing of lamictal with carbamazepine, phenobarbital, and phenytoin

Answer 26

start higher at 50 mg/day for two weeks up to 400 mg/day. Split dose to BID when you get to 100 mg

Question 27

Can cause weight gain

Answer 27

Depakote

Monitor weight and BMI

Question 28

Common side effects of Depakote

Answer 28

GI Irritation
Nausea
Sedation
Tremor
Weight Gain
Hair loss (take zinc)
Decreased Calcium and VD