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Psychiatry > Mood Stabilizers Jeopardy > Flashcards

Mood Stabilizers Jeopardy Flashcards

1
Q

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

A

12 hours (trough)

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2
Q

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

A

0.6-0.8 mEq/L

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3
Q

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

A
  • TSH

- BUN/Creatinine

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4
Q

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

A
  • 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

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

Suicide

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7
Q

Lithium toxicity with a lithium level greater than __ mEq/L is treated with dialysis.

A

4.0 mEq/L

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8
Q

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

A

5 days

T1/2 ~ 24hrs

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9
Q

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

A

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

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
  • LFTs

- 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

Decrease lamotrigine dose by half

Valproic acid is an inhibitor of CYP2C9

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13
Q

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

A

Tremor

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14
Q

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

A

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

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

Headache (indicated for migraine ppx)

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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

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

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

Auto-induction

20
Q

Exposure of the fetus to carbamazepine (Tegretol) during the 1st trimester of pregnancy leads to an unacceptable risk of this:

A

Neural tube defects

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
  • Agranulocytosis

- Aplastic anemia

22
Q

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

A

Sodium

23
Q

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

A

CYP 3A4

24
Q

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

A

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

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

LFTs

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

Folate (B9)

28
Q

Patients who start taking lamotrigine (Lamictal) have a __ % risk of developing a benign rash:

A

10%

29
Q

While the side effect of a benign rash with lamotrigine is relatively common (10%), the risk of a severe rash is about 0.3%, and the risk of this is about 0.02-0.1%.

A

SJS

30
Q

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

A

Increasing (doubles)

31
Q

Lamotrigine (Lamictal), quetiapine (Seroquel), lithium, olanzapine/fluoxetine (Symbyax), and lurasidone (Latuda) all have this in common regarding their usage in
the treatment of pts with bipolar disorder:

A

FDA-approved for tx of bipolar DEPRESSION

32
Q

Lamotrigine (Lamictal), lithium, quetiapine (Seroquel), olanzapine/fluoxetine (Zyprexa) and aripiprazole (Abilify) all have this in common regarding their usage in treatment of pts with bipolar disorder:

A

FDA-approved for use in maintenance treatment of BD

33
Q

Lithium, divalproex (Depakote), carbamazepine ER (Tegretol ER), quetiapine (Seroquel), ziprasidon (Geodon), and asenapine (Saphris) are FDA-indicated to treat this phase of bipolar disorder, but lamotrigine (Lamictal) is not.

A

Acute manic episode

34
Q

Lithium, divalproex (Depakote), quetiapine (Seroquel), and olanzapine/fluoxetine (Zyprexa) with regard to these two common side effects are NOT side effects of lamotrigine (lamictal).

A
  • Weight gain

- Sedation

35
Q

The common mechanism of action for the mood stabilizers carbamazepine (Tegretol), divalproex (Depakote), and lamotrigine (Lamictal) is blocking these.

A

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

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

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

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

Resperidone (Risperdal)

40
Q

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

A

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
  • 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

ziprasidone (Geodon)

43
Q

These 3 SGA’s are FDA indicated for treating bipolar depression; two by themselves, the other in combination with fluoxetine (Prozac).

A
  • Quetiapine (Seroquel)
  • Lurasidone (Latuda)
  • Olanzapine w/fluoxetine (Zyprexa)
44
Q

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

A
  • aripiprazole (Abilify Maintena)

- olanzapine (Zyprexa Relprevv)

Psychiatry (16 decks)

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