Ott Bipolar

Question 1

mood pole often experienced in bipolar

Answer 1

depression

Question 2

comorbidities with bipolar

Answer 2

alcohol and substance abuse
anxiety disorder

Question 3

bipolar 1 disorder classification

Answer 3

greater than 1 manic episodes

Question 4

bipolar II disorder classification

Answer 4

hypomanic episodes

Question 5

1st line treatment bipolar

Answer 5

lithium or valproic acid

Question 6

lithium associated with what

Answer 6

decrease in suicidality
narrow therapeutic index (could overdose)

Question 7

dosage forms of lithium ratio

Answer 7

1:1

Question 8

what can happen if a lithium overdose

Answer 8

renal function decrease, dialysis

Question 9

lithium toxicities

Answer 9

GI
ataxia
coarse hand tremor
altered mental status
seizure lethargy
confusion
agitation

Question 10

lithium side effects

Answer 10

fine hand tremor
hypothyroidism
polyuria
polydipsia
acne
dry mouth
weight gain
ECG

Question 11

lithium should be avoided when?

Answer 11

1st trimester (teratogenic)
cause cardiac structural abnormality

Question 12

lithium monitoring

Answer 12

everything
renal stuff especially

Question 13

drug interactions with lithium decreased clearance

Answer 13

ACE
ARB
thiazide diuretics
NSAIDS
(increase lithium levels 25%)

Question 14

drug interactions with lithium increased clearance

Answer 14

caffeine
osmotic diuretics
loop diuretics
(decrease lithium levels)

Question 15

which drug available in multiple dosage forms and risk for med errors

Answer 15

valproate

Question 16

which dosage form less bioavailable than DR

Answer 16

ER - 10-15%, lower serum concentrations

Question 17

which valproate dosage forms higher risk for side effects

Answer 17

valproic acid syrup (IR) and capsule sprinkle
higher risk for GI ulcers (esophageal)

Question 18

serum valproic acid range for efficacy with mania and when should we measure

Answer 18

80-125 mcg/mL, obtain 4 days after first dose or increase

Question 19

pregnancy with valproic acid

Answer 19

unsafe in all trimesters
obtain baseline pregnancy test
neural tube defects (IQ of offspring down)

Question 20

common side effect of valproic acid in women

Answer 20

polycystic ovary syndrome

Question 21

PCOS can occur with what drug

Answer 21

valproic acid

Question 22

side effects valproic acid

Answer 22

anorexia, N/V/D, dyspepsia, ulceration
increased appetite/weight gain
thrombocytopenia, platelet dysfunction
hyperammonemia

Question 23

lab monitoring in valproic acid

Answer 23

pregnancy test
LFTs
CBC
serum ammonia (if we suspect hyperammonemia)

Question 24

drug interaction with valproic acid

Answer 24

lamotrigine - increased serum conc
risk stevens johnson syndrome

Question 25

which drug associated with thrombocytopenia/hematologic effects

Answer 25

carbamazepine

Question 26

oxcarbazepine CYPs

Answer 26

3A4 inducer (no autoinduction)

Question 27

which drug associated with hyponatremia

Answer 27

oxcarpazepine

Question 28

lamotrigine use in bipolar

Answer 28

depressive symptoms Not useful in manic symptoms or acute treatment

Question 29

topiramate side effects

Answer 29

weight loss heat intolerance metabolic acidosis kidney stones

Question 30

topiramate pregnancy

Answer 30

possible teratogen cardiac structural defects

Question 31

atypical antipsychotics are approved for what in bipoilar

Answer 31

acute/maintenance treatment with or without psychosis

Question 32

which antipsychotics arent FDA approved for bipolar

Answer 32

brexiprazole clozapine iloperidone paliperidone

Question 33

atypical antipsychotics in bipolar therapy

Answer 33

monotherapy or in combo with (valproate/lithium)

Question 34

what applies for antipsychotics in bipolar disorder

Answer 34

monitoring parameters for metabolic syndrome and movement side effects

Question 35

suicide risk in which pole of bipolar

Answer 35

mania and depression (use lithium cautiously)

Question 36

which drugs are teratogens

Answer 36

lithium valproic acid topiramate carbemazepine

Question 37

which drugs better option in pregnancy

Answer 37

antipsychotics

Question 38

what do we need in combo with antidepressants in bipolar?

Answer 38

mood stabilizer

Question 39

what do we treat anxiety with in bipolar

Answer 39

serotenergic antidepressants

Question 40

preferred mood stabilizers in depression

Answer 40

lamotrigine, lithium, lurasidone, quetiapine