RxPrep Bipolar Disorder

a) bipolar I

At least one episode of mania, and usually, bouts of (+/-) intense depression

a) bipolar I

b) bipolar II

c) bipolar depression

d) psychosis

true

True or False: A depressive episode is not required for diagnosis of bipolar I.

mania

(Hypomania/Mania) is associated with at least one of the following: significant impairment in social/work functioning, psychosis/delusions, or requires hospitalization.

b) bipolar II

At least one episode of hypomania and at least one depressive episode

a) bipolar I

b) bipolar II

c) bipolar depression

d) psychosis

≥4

For bipolar II diagnosis, hypomania must last ________ consecutive days.

≥2 weeks

How long must a depressive episode last for diagnosis of bipolar II?

hypomania

(Hypomania/Mania) does not affect social/work functioning, doesn't cause psychosis, nor require hospitalization.

c) bipolar depression

Feelings of sadness or depressed mood and/or loss of interest in previously enjoyed activities

a) bipolar I

b) bipolar II

c) bipolar depression

d) psychosis

d) psychosis

Severe mental condition where there's a loss of contact with reality, involves abnormal thinking and perception

a) bipolar I

b) bipolar II

c) bipolar depression

d) psychosis

bipolar disorder

________ is characterized by fluctuations in mood from an extremely sad or hopeless state to an abnormally elevated, overexcited, or irritable mood.

severity of mania

What is the main difference between bipolar I and II?

DSM-5

What is used to diagnose bipolar disorder?

mania

abnormally elevated or irritable mood for at least a week (or any duration if hospitalization is needed); symptoms include inflated self-esteem, less sleep required, more talkative than normal, jumping from topic to topic, easily distracted, increase in goal-directed activity, high-risk pleasurable activities

≥3; ≥4

To diagnose mania, there must be ________ symptom(s) present. If mood is only irritable and not elevated, there must be ________ symptom(s) present.

stabilize mood without inducing a depressive or manic state

What is the goal of treatment for bipolar disorder?

antiepileptic drugs, lithium

What are the 2 traditional mood stabilizers used in bipolar disorder?

carbamazepine, lamotrigine, valproate

What 3 antiepileptic drugs are commonly used as mood stabilizers for bipolar disorder?

mood stabilizers

________ treat both mania and depression without inducing either state.

antipsychotics

________, while not traditional mood stabilizers, can help stabilize the mood when mania occurs with psychosis.

antidepressants

(extra FYI: lamotrigine (anticonvulsant) as monotp = no efficacious)

________ can induce or exacerbate a manic episode when used as monotherapy, so they should only be used in combination with a mood stabilizer.

antipsychotic (SGA), lithium, valproate

What 3 drugs/classes are first-line for acute treatment of a manic episode?

antipsychotic (SGA);

lithium, valproate

A combination of a(n) ________ with ________ or ________ is first-line for acute treatment of severe manic episodes.

antipsychotic (SGA)

What drug class is first-line for acute treatment of a depressive episode?

lamotrigine, lithium, valproate

What 3 drugs can be added to first-line treatment or can be used as alternatives for acute treatment of a depressive episode?

antiepileptic drugs, lithium, second-generation antipsychotics

What 3 drugs/classes should be used as maintenance therapy for bipolar disorder?

combination therapy

(Combination therapy/Monotherapy) might be more effective than monotherapy at preventing relapse.

antidepressants

MedGuides are required with all (antidepressants/antipsychotics) primarily due to their risk of suicide.

antipsychotics

MedGuides are required with all (antidepressant/antipsychotics) due to increased risk of death in elderly patients with dementia-related psychosis.

b) lamotrigine

Which antiepileptic drug requires a slow titration due to the risk of a severe rash?

a) carbamazepine

b) lamotrigine

c) valproate

b) lamotrigine

no efficacy evidence when used alone

lamotrigine laments because it cannot be used alone - it has to have another with it

Which antiepileptic drug should not be used for acute mania?

a) carbamazepine

b) lamotrigine

c) valproate

Lamictal

What is the brand name for lamotrigine?

Depakote

What is the brand name for divalproex?

extrapyramidal symptoms

What is a major concern with antipsychotics?

first

The (first/second)-generation antipsychotics have a higher incidence of extrapyramidal symptoms.

second

(First/Second)-generation antipsychotics are preferred for the treatment of bipolar disorder.

aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone

ROQA-Z

What are 5 of the more common second-generation antipsychotics that can be used alone or in combination with mood stabilizers for acute mania and/or maintenance treatment of bipolar disorder?

Abilify

What is the brand name for aripiprazole?

Zyprexa

What is the brand name for olanzapine?

Seroquel

What is the brand name for quetiapine?

Risperdal

What is the brand name for risperidone?

Geodon

What is the brand name for ziprasidone?

lurasidone

What second-generation antipsychotic can be used alone or in combination with mood stabilizers for bipolar depressive episodes?

Latuda

What is the brand name for lurasidone?

olanzapine/fluoxetine (Symbyax)

What drug can be used alone for acute depressive episodes in bipolar disorder?

lithium

What drug is proposed to work by influencing the reuptake of serotonin and/or norepinephrine or by moderating glutamate levels in the brain?

glutamate

What is the primary excitatory neurotransmitter in the brain?

mania

What could high levels of glutamate cause?

Lithobid

What is the brand name for lithium?

0.6-1.2 mEq/L

LITHIUM batteries come in a 6pk or a 12 pk)

What is the therapeutic trough level range for lithium?

serotonin syndrome

What warning is associated with lithium use?

cognitive effects, cogwheel rigidity, fine hand tremor, GI upset, hypothyroidism, polyuria, thirst, weight gain

What are 8 side effects associated with lithium within the therapeutic range?

ataxia, coarse hand tremor, vomiting

What are 3 side effects of lithium toxicity when trough levels are >1.5 mEq/L?

arrhythmia, CNS depression, coma, seizure

What are 4 side effects of lithium toxicity when trough levels are >2.5 mEq/L?

renal function (renally elimated),

serum lithium levels (toxicity),

thyroid function (a/e = hypothyroidism)

What are 3 monitoring parameters for lithium?

false (renally cleared so no interactions)

True or False: Lithium has many CYP450 interactions.

ACE inhibitors, ARBs, decreased salt intake, NSAIDs

(also thiazides, ccbs, dehydration)

What 4 things can cause increased lithium levels?

increased salt intake

(also caffeine, theophylline)

What can decrease lithium levels?

linezolid, SNRIs, SSRIs, triptans

(also TCAs, methylene blue, DM etc)

There's an increased risk for serotonin syndrome if lithium is taken with what 4 drugs/classes?

8

5 mL lithium citrate syrup = ________ mEq of lithium ion

300

8 mEq of lithium ion = ________ mg lithium carbonate tablets/capsules

7.5 mL

300 mg / 8 mEq = 450 mg / x

3600 = 300x

x = 12 mEq

5 mL / 8 mEq = x / 12 mEq

60 = 8x

x = 7.5 mL

A patient is taking 450 mg lithium carbonate BID, but reports difficulty swallowing the capsules. How many mL of lithium citrate syrup should be given for each dose? (round to the nearest tenth)

c) valproate

Which of the following has an increased risk of fetal anomalies including neural tube defects and long-term adverse cognitive effects?

a) carbamazepine

b) lithium

c) valproate

a) carbamazepine (avoid in 1st trimester if needed to use in pregnancy)

face cream - carbamezapine kinda rhymes with cream)

What of the following has a risk of facial abnormalities and other significant issues associated with use during pregnancy?

a) carbamazepine

b) lithium

c) valproate

b) lithium

think about grandma - she had heart defect and lithium is "old" drug

Which of the following can cause an increase in congenital cardiac malformations and other abnormalities?

a) carbamazepine

b) lithium

c) valproate

carbamazepine, lithium, valproate

What 3 drugs used to treat bipolar disorder should be avoided in pregnancy?

lamotrigine

What drug is a safer option for a mood stabilizer to treat bipolar disorder in pregnancy?

second-generation antipsychotics

What drug class is safer than most mood stabilizers when treating bipolar disorder in pregnancy?

lurasidone

What drug has the most favorable safety profile in pregnancy but has limited use since it's only approved for bipolar depression?

take with food or at end of meal

What can be done to reduce nausea when taking lithium?

salt

Changes in ________ intake can alter lithium levels in the body.

dehydration

What should be avoided when taking lithium due to the possibility of increased levels and side effects?

alertness

Lithium can impair ________.