Mood Stabilizers Jeopardy

Question 1

lithium Trough level drawn at?

Answer 1

12 hours after last dose

Question 2

Lithium

Answer 2

TX: bipolar disorder
levels above 0.6-0.8 mEq/L

Male pts before starting- do labs (TSH, BUN/creatine)

maintenance labs - TSH, lithium levels, BUN/creatine

DEC suicide risk
TX acute manic episode

AE - Weight gain, sedation

T1/2 = 5 days (check levels at day 5 after starting)

Question 3

Tremors

Answer 3

lithium AE
worsen by caffeine
improved w/ propranolol

Question 4

Lithium toxicity

Answer 4

> 4.0 mEq/L
TX - Dialysis

INC risk x pts: renal impairment, sodium depletion, dehydration

Question 5

Divalproex Sodium

Depakote

Answer 5

first trimester of pregnancy: INC risk of neural tube defects (spina bifida)

Labs: LFT’s, platelets

AE - HA, weight gain, sedation
INC risk 2 yo - AE: fatal, hepatoxicity

TX - prophylaxis migraine

after last dose
trough level (immediate release) - 12 hrs
trough level (extended release) - 18 hrs

+aspirin -> INC risk thrombocytopenia (dec platelets)

Question 6

generic Valproic acid (depakene) VS enteric coated divalproex (depakote)

Answer 6

INC risk of GI side effect
(N/V/D, GI discomfort)

Labs: blood levels, platelets/blood count/Liver function test

Question 7

Carbamazepine

tegretol

Answer 7

T1/2 dec to less than 50% of initial bc of auto-induction

neural tube defects - first trimester

black box 0.001%: agranulocytosis, aplastic anemia

Low Sodium

CYP3A4 - inducer, substrate

+hormonal birth control: INC risk of pregnancy

Labs: blood levels, platelets/blood count/Liver function test

Question 8

Oxcarbamazepine

trileptal

Answer 8

TX - bipolar disorder

fewer AE than carbamazepine

Question 9

Folate

Answer 9

DEC risk of birth defects

women taking carbamazepine

Question 10

Lamotrigine

lamictal

Answer 10

10% of developing benign rash

severe rash 0.3%

Steven’s Johnson Syndrome 0.02 - 0.1%

NOT x acute manic episode
NO weight gain, NO sedation

Question 11

Lamitrogen + Divalproex sodium

Answer 11

lamictal’s blood level INC (DOUBLES)

+ Lamotrigine -> dec [ ] of lamotrigine dose by half

Question 12

Bipolar Depression TX FDA

Answer 12

Lamotrigine (lamictal) 
Quetiapine (seroquel)
lithium
Olanzapine/fluoxetine (symbyax)
lurasidone (Latuda)

Question 13

Bipolar TX-Maintenance

Answer 13

Lamotrigine
Lithium
Quetiapine
Olanzapine
Aripiprazole

Question 14

Acute manic episode TX

Answer 14

Lithium
Divalproex
Carbamazepine ER
Quetiapine
Ziprasidone
Asenapine

Question 15

MOA:
Carbamazepine
Divalproex
Lamotrigine

Answer 15

mood stabilizers

Block sodium channels

Question 16

Olanzapine

Zyprexas

Answer 16

SGA
TX: acute manic, maintenance and tx bipolar

long acting injectable form

AE - weight gain, elevated lipids, diabetes

Question 17

Ziprasidone

geodon

Answer 17

TX - acute mania, maintenance and tx bipolar

taken with FOOD or >50% will not be absorbed in digestive tract

NO metabolic syndrome

CI: QTc >500msec

Question 18

Aripiprazole

abilify

Answer 18

SGA
TX - acute mania, maintenance and tx bipolar

LONG T1/2 = 75 hrs
long acting injectable form

steady sate @ 2 weeks

NO metabolic syndrome

Question 19

Risperidone

risperdal

Answer 19

SGA
TX - acute mania, maintenance and tx bipolar

at HIGH doses (>6mg) = FGA
INC AE - EPS

long acting injectable form

Question 20

Asenapine

saphris

Answer 20

SGA
TX - acute mania

SUBLINGUAL
if swallowed, 5% bioavailability (1st pass metabolism)

Question 21

Paliperidone

invent sustenna

Answer 21

SGA

long acting injectable form