Pharmacotherapy of Bipolar Disorders- Dr. Hager

Question 1

Given treatment resistance and intolerance to SSRI and SNRI medications with a concern for obesity, which medication is the best next step for this patient

Answer 1

• Bupropion

- Can actually cause weight loss

Question 2

Bipolar I

Answer 2

• Mania
• Major depression
• Requires hospitalization

Question 3

Bipolar II

Answer 3

• Hypomania

- Major depression

Question 4

Cyclothymic disorder

Answer 4

Sub threshold

• Hypomania
• Depression

Question 5

Mania definition

Answer 5

• Distinct period
• Abnormal
• Persistent
• Irritable mood
• Increased activity/energy
• Greater than 1 week
• Usually requires hospitalization

Question 6

Hypomania

Answer 6

• 4 to 6 days
• Not severe enough to cause impairment or hospitalization
• No psychosis

Question 7

Screening for bipolar disorder

Answer 7

• MDQ > 7

- Self reported scale

Question 8

Non-Response

Answer 8

-Less than 25% reduction

Question 9

Partial respones

Answer 9

-Between 25 and 50% response

Question 10

Response

Answer 10

-Greater than 50% reduction in symptoms

Question 11

Remission

Answer 11

-Absence of mood symptoms for greater than 2 months

Question 12

Maintenance phase

Answer 12

-Prevent relapse to any mood episode

Question 13

Standardized mean difference (SMD) equation

Answer 13

(Treatment effect - Placebo effect)/ Std Dev

Question 14

Number needed to treat (NNT) equation

Answer 14

1/ARR

Question 15

Name a drug that is NOT efficacious for acute mania

Answer 15

-Lamotrigine

Question 16

First generation antipsychotics (FGA) mechanism of action

Answer 16

-D2 antagonist

Question 17

List FGAs

Answer 17

• Haloperidol & Fluphenazine
• Perphenazine
• Chlorpromazine & Thioridazine

Question 18

Second generation antipsychotic (SGA) TWO mechanisms of action

Answer 18

1) D2 antagonist and 5HT2 antagonist

2) D2 partial agonist and 5HT2 antagonist

Question 19

List D2/5HT2 antagonist (SGAs)

Answer 19

• Risperidone, Olanzapine
• Ziprasidone, Lurasidone
• Quetiapine, Clozapine

Question 20

List D2 partial agonist and 5HT2 antagonist

Answer 20

• Aripiprazole
• Brexpiprazole
• Cariprazine

Question 21

Which antipsychotics have minimal neuroleptic potential

Answer 21

• Clozapine

- Quetiapine

Question 22

Which antipsychotics have a fast off (kiss-and-go) effect

Answer 22

• Clozapine
• Quetiapine
• Olanzapine

Question 23

Is lamotrigine an ideal mood stabilizer?

Answer 23

-NOOOO

Question 24

Name some drugs with NO mood stabilizing effects

Answer 24

• Phenytoin
• Gabapentin
• Topiramate
• Benzodiazepines

Question 25

What phases of bipolar disorder are treated by Ideal mood stabilizers

Answer 25

ALL phases: - Acute Mania - Acute Depression - Maintenance

Question 26

List the Ideal mood stabilizers that we learned about in class

Answer 26

- Olanzapine/Fluoxetine - Olanzapine - Quetiapine - Valproate - Lithium + Valproate - ECT

Question 27

List the side effects associated with lithium

Answer 27

- Polyuria, diabetes insipidus - Cognitive slowing, tremor, sedation - Weight gain, hypothyroidism - Nausea, diarrhea

Question 28

Lithium can be used to treat what?

Answer 28

- Acute mania - Acute bipolar depression - Prevention of bipolar disorder relapse - Augmentation for acute unipolar depression

Question 29

Can quetiapine be used for acute bipolar depression?

Answer 29

-Yes ma'am

Question 30

What are possible side effects of SGAs

Answer 30

- Orthostatic hypotension - QT prolongation - Psuedoparkinsonism - Weight gain - Dyslipidemia - Neutropenia

Question 31

Which antipsychotic is least likely to cause QT prolongation

Answer 31

-Aripiprazole

Question 32

Agents that can cause weight gain

Answer 32

- Olanzapine - Gabapentin - Amitriptyline - MIrtazapine - Quetiapine - Risperidone

Question 33

Agents that can cause weight loss

Answer 33

- Topiramate - Bupropion - Fluoxetine

Question 34

Is paroxetine safe in pregnancy?

Answer 34

-NOOOOOO

Question 35

Is Olanzapine safe in pregnancy?

Answer 35

-Yes ma'am

Question 36

Which agents are pregnancy category "D"

Answer 36

- Lithium - Valproate - Carbamazepine

Question 37

Which agents are pregnancy category "C"

Answer 37

- Lamotrigine - Antipsychotics - ETC

Question 38

List some possible side effects of Carbamazepine

Answer 38

- Cytopenia, agranulocytosis - Steven johnsons - Dizziness/ ataxia - Hyponatremia - Does NOT cause insomnia

Question 39

What is a common side effect of lamotrigine

Answer 39

-Benign drug rash

Question 40

What is more common: bipolar disorder or anxiety/depressive disorder

Answer 40

-Depressive/ anxiety disorders