Bipolar Disorder

Question 1

Rapid Plasma Reagin (RPR) tests for what to rule out other causes of disorganized behavior

Answer 1

syphilis

Question 2

if a first degree relative has bipolar there is what

Answer 2

increase risk of also having BPD

Question 3

bipolar has shown to have these abnormalities in the brain

Answer 3

changes in the amygdala and prefrontal cortex

Question 4

what is the difference between mania vs hypomania

Answer 4

all of the same sx but hypomania is NOT causing a marked impaired function and/or doesnt need hospitlization

Question 5

is a depression episode required for bipolar diagnosis

Answer 5

nope but it’s common

Question 6

symptoms of facial grimace and rapid eye blinking are most likely signs of this EPS symptom

Answer 6

tardive dyskinesia

Question 7

for short term agitation the guidelines are recommend what

Answer 7

starting oral maintenance anti-manic if px agrees

can do IM meds (lorazepam 2 mg, OLZ 2.5 mg , droperidol 5 mg)

Question 8

you should never administer these to parenteral drugs together due to risk of hypotension and resp depression

Answer 8

lorazepam and olanzapine

Question 9

CANMAT recommendations for acute mania 1st line

Answer 9

Lithium
quetiapine
divalproex
asenapine
aripiprazole
paliperidone
risperidone
cariprazine

Question 10

what is more effect mono or combo and what class works faster

Answer 10

Combo

second gen antipsychotic

Question 11

CANMAT recommendations for bipolar depression 1st line

Answer 11

quetiapine
lurasidone
Lithium
lamotrigine
lurasidone+ Li/DVP

Question 12

Lithium has an interesting interaction with this element

Answer 12

sodium Na

they move together so important to maintain a consistent sodium intake

Question 13

Lithium has DDI with

Answer 13

diuretics: may lower lithium levels

ACE/ARB, NSAID: may increase lithium levels

Question 14

when should you get a Lithium level and what are the goals

Answer 14

12 hr level

acute: 0.8-1.2 mEq/L
maintain: 0.6-1 mEq/L

Question 15

Lithium is a good drug because its known to decrease….

Answer 15

suicide risks

Question 16

Lithium ADE

Answer 16

GI upset
tremor
Diabetes insipidus
renal dysfunction
hypothyroidism
leukocytosis
acne/psoriasis
weight gain
impaired memory/concentration
ebstein anomaly (teratogenic)

Question 17

when does Lithium toxicity occur

Answer 17

Lithium levels >1.5 (mild) >2 (severe)

Question 18

mild and severe symptoms of Lithium toxicity

Answer 18

M: GI intolerance, worsened tremor, drowsiness, ataxia

S: seizure, coma, arrhythmia, death

Question 19

divalproex is an antiepileptic that is used as a mood stabilizer because it has this MOA

Answer 19

increases GABA at postsynapic receptors

Question 20

what level of divalproex is the goal and when do we take these levels

Answer 20

85 -125 mcg/mL

12 hr if DR/IR
24 hr if ER **

Question 21

Divalproex ADE

Answer 21

BW: HEPATIC FAIL/PANCREATITIS

Fetal valproate syndrome (teratogenic)

Gi upset
somnolence
dizziness
alopecia
PCOS
thrombocytopenia
rash
weight gain
hyperammonemia

Question 22

second gen antipsychs have LA injectables that work more quickly than traditional mood stabilizers whats the difference

Answer 22

2 days vs 1 week

Question 23

what do you need to monitor second gen antipsychs

Answer 23

monitor EPS

no drug levels and titrate to response and tolerability

Question 24

second gen antipsych ADE

Answer 24

decrease seizure threshold
sedation
weight gain
QTc prolongation
hyperprolactinemia
anticholinergic
EPS: akathisia, dystonia, pseudoparkinsonism, tardive dyskinesia

Question 25

lamotrigine is an anticonvulsant used as a mood stabilizer but it is only used for this type of bipolar

Answer 25

bipolar depression (not good in anti-manic)

Question 26

Lamotrigine has a BBW of… and these other SE

Answer 26

rash!

dizzy, nausea, diplopia

Question 27

lamotrigine has DDI with

Answer 27

Valproate (use 1/2 normal dose) and oral contraceptives

Question 28

CBZ is an anticonvulsant that is used as a mood stabilizer but you need to monitor closely because of…

Answer 28

auto-induction of metabolism 3-4 wks after starting

Question 29

CBZ is shown to be good for ___ compared to ____

Answer 29

acute mania compared to mixed episodes

Question 30

CBZ has DDI with

Answer 30

VPA by displacing it from binding sites meaning increased CBZ levels

Question 31

goal trough of CBZ

Answer 31

4-12 mcg/mL

Question 32

CBZ ADE and BW

Answer 32

BW: agranulocytosis, aplastic anemia, rash!!

dizzy
Gi upset
sedation
hyponatremia/SIADH
ataxia

Question 33

What should be tested in patients taking CBZ?

Answer 33

HLA-B 1502* testing required esp for Asian descent

Question 34

if a px is started on Li but is on lisinopril what is likely to happen

Answer 34

Li toxicity causing tremor, drowsiness, and ataxia

Question 35

a px received divalproex ER 2000 mg for bipolar and got a 12 hr trough drawn interpret these results.

Answer 35

you cant because it was drawn wrong! needs to be 24 hrs

Question 36

what medication is not a good choice for a manic episode
-Lithium
-divalproex
-lamotrigine
-paliperidone

Answer 36

lamotrigine

Question 37

a px being treated with 2nd gen antipsych for bipolar and the px complains of restlessness and feelings of needing to move. what is the most likely cause

-tardive dyskinesia: aripiprazole
-akathisia: aripiprazole
-hyperprolactinemia: paliperiodne
-akathisia: paliperidone

Answer 37

akathisia: aripiprazole