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PHRM 845 Therapeutics > Exam 5 - Lec 70 Bipolar Ott > Flashcards

Exam 5 - Lec 70 Bipolar Ott Flashcards

1
Q

_______ is the mood pole that is experienced most often in bipolar disorder - can lead to misdiagnoses

A

depression

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2
Q

alcohol and substance abuse is common (___-___%) in bipolar disorder

A

50-60%

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3
Q

T or F: Anxiety disorders are common comorbidities and can significantly impact remission of mood episodes if left untreated or inadequately treated

A

T

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4
Q

bipolar I disorders requires at least ___ manic episdoes

A

1

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5
Q

bipolar II disorder includes major depressive and __________ episodes

A

hypomanic

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6
Q

T or F: lithium is associated with an increase in suicidality

A

F (dec)

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7
Q

T or F: lithium is a narrow therapeutic index (NTI) medication

A

T

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8
Q

what is the conversion for lithium liquid vs tablets/capsules?

A

1:1 conversion

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9
Q

acute lithium tx

a. 0.9-1.2 mEq/L
b. 0.6-0.9 mEq/L
c. 1.5 - > 3.0 mEq/L

A

a. 0.9-1.2 mEq/L

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10
Q

maintenance lithium tx

a. 0.9-1.2 mEq/L
b. 0.6-0.9 mEq/L
c. 1.5 - > 3.0 mEq/L

A

b. 0.6-0.9 mEq/L

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11
Q

lithium toxicity (mild to severe)

a. 0.9-1.2 mEq/L
b. 0.6-0.9 mEq/L
c. 1.5 - > 3.0 mEq/L

A

c. 1.5 - > 3.0 mEq/L

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12
Q

we should draw trough serum lithium conc ___ hours after dose initiation, ___ hours after last dose

A

72; 12

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13
Q

look at slide 12 for lithium toxicities and SE

A

you got it

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14
Q

T or F: lithium is preferred in 1st trimester of pregnancy

A

F (avoid in 1st trimester - use with caution in 2nd and 3rd trimester)

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15
Q

what cardiac structure abnormality can lithium cause?

A

Ebstein’s anomaly

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16
Q

look at slide 13 for lithium lab monitoring

A

ok

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17
Q

lithium drug interactions: ACEi, ARBs, thiazides, NSAIDs, dehydration

a. dec Li renal clearance
b. inc Li renal clearance
c. inc Li excretion

A

a. dec Li renal clearance

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18
Q

lithium drug interactions: caffeine, osmotic diuretics, +/- loop diuretics

a. dec Li renal clearance
b. inc Li renal clearance
c. inc Li excretion

A

b. inc Li renal clearance

19
Q

lithium drug interactions: sodium bicarb, high Na intake

a. dec Li renal clearance
b. inc Li renal clearance
c. inc Li excretion

A

c. inc Li excretion

20
Q

lithium toxicity related to Na depletion is due to which diuretics?

a. thiazides
b. loops
c. osmotic

A

a. thiazides

21
Q

ER valproate is ~___-___% less bioavailable than delayed release (DR) dosage form

A

10-15%

22
Q

T or F: valproic acid syrup (IR) and capsule sprinkle form has higher risk for GI ulcerations (usually esophageal)

A

T

23
Q

conversion for ER valproate and DR valproate

A

1:1; expect lower serum conc with the ER form - usually not clinically signif

24
Q

valproate serum levels _____-_____ mcg/mL is associated with the most efficacy in mania

A

80-125

25
Q

for valproate, serum levels should be obtained at least ___ hours after first dose or dose increase

A

96 (4 days)

26
Q

T or F: valproate is used in 1st trimester, but shouldn’t be used 2nd or 3rd trimester

A

F (unsafe in any trimester, get baseline pregnancy test)

27
Q

PCOS occurs in up to ___% of women on valproate

A

50%

28
Q

look at slide 15 for AEs of valproate

A

sure

29
Q

look at slide 16 for lab monitoring for valproate

A

okay

30
Q

valproate and lamotrigine being used together will inc lamotrigine serum conc and increased risk of ?

A

Stevens-Johnson syndrome

31
Q

carbamazepine is associated with

a. thrombocytopenia/hematologic effects
b. hyponatremia
c. heat intolerance

A

a. thrombocytopenia/hematologic effects

32
Q

oxcarbazepine is associated with

a. thrombocytopenia/hematologic effects
b. hyponatremia
c. heat intolerance

A

b. hyponatremia

33
Q

oxcarbazepine is a ___ inducer

A

3A4

34
Q

which mood stabilizer is 1st line for depressive sx in bipolar disorder?

a. lamotrigine
b. topiramate
c. carbamazepine
d. oxcarbazepine

A

a. lamotrigine

35
Q

T or F: lamotrigine is useful for acute tx or for manic disorders

A

F (not useful)

36
Q

which mood stabilizer may cause weight loss, heat intolerance/hypohidrosis, metabolic acidosis, and kidney stones?

a. carbamazepine
b. oxcarbazepine
c. lamotrigine
d. topiramate

A

d. topiramate

37
Q

which mood stabilizer is a POSSIBLE teratogen - cardiac structural defects?

a. carbamazepine
b. oxcarbazepine
c. lamotrigine
d. topiramate

A

d. topiramate

38
Q

T or F: atypical antipsychotics may be used as monotherapy or can be used combination with other mood stabilizers (usually valproate or lithium)

A

T

39
Q

T or F: pts on antipsychotics for bipolar disorder should be monitored for metabolic syndrome and movement SE

A

T

40
Q

T or F: mood stabilizer tx is short-term and considered to be adjunct tx to reduce time to subsequent mood episodes

A

F (long-term, maintenance tx not adjunct)

41
Q

which of the following is not one of the 4 known or possible teratogens for bipolar?

a. lithium
b. lamotrigine
c. valproate
d. carbamazepine
e. topiramate

A

b. lamotrigine

42
Q

T or F: if using antidepressants in bipolar disorder, they need to be in combo with maintenance mood stabilizer therapy

A

T

43
Q

we use __________ antidepressants to treat anxiety in bipolar disorder

a. dopaminergic
b. serotonergic
c. noradrenergic

A

b. serotonergic

44
Q

4 mood stabilizers that target the depressive pole

A

lamotrigine
lithium
lurasidone
quetiapine

PHRM 845 Therapeutics (34 decks)

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