bipolar

Question 1

Medical conditions inducing mania

Answer 1

1. cns (strokes, head injuries, multiple sclerosis)
2. endocrine (cushing’s disease, hyperthyroid - mania, hypothyroid - depression)
3. electrolyte/metabolic abnormalities
4. cns infections

Question 2

drugs inducing mania

Answer 2

alcohol intoxication, drug withdrawal states, antidep, DA agonists, NA agonists, steroids, thyroid preparations, pseudoephedrine, st john’s wort

Question 3

recite DIGFAST

Answer 3

Distractibility and easily frustrated
Irresponsibility
Grandiosity
Flight of ideas
Activity increased
Sleep: decreased need (less than 3 hours)
Talkativeness

Question 4

diagnosing mania

Answer 4

symptoms more than 1 week

Question 5

hypomania

Answer 5

no functional impairment, no psychosis

Question 6

what to test prior to CMZ

Answer 6

HLAB*1502 genotype test

Question 7

what labs

Answer 7

fbc, u/e/cr, LFTs, TFTs, pregnancy test,

Question 8

treatment goals

Answer 8

1. reduce frequency, severity and duration of mood episodes
2. prevent suicide

Question 9

preferred antipsychs for mania

Answer 9

olanzapine - best effect for mania
risperidone - mania inducing psychosis
quetiapine - sedating properties

Question 10

suicide prevention

Answer 10

lithium,

but if poorly tolerated: olanzapine, quetiapine

Question 11

bipolar depression treatment

Answer 11

lithium, quetiapine, olanzapine with fluoxetine

Question 12

can lamotrigine be used for bipolar depression

Answer 12

yes, but no anti-manic properties

Question 13

avoid valproate in?

Answer 13

child bearing potential females

Question 14

moa of lithium

Answer 14

decrease 5ht reuptake and dopamine release

Question 15

se of lithium

Answer 15

HYPOTHYROIDISM, acne, tremors, polyuria, ecg changes, nausea, weight gain

Question 16

increased toxicity of lithium with STAND

Answer 16

decreased sodium levels,
thiazides,
acei/arb
nsaids
dehydration

Question 17

sodium valproate moa

Answer 17

increases gaba levels, decrease dopamine turnover,
normalises Na+ and Ca+ channels

Question 18

sodium valproate ddi

Answer 18

lamotrigine (risk of sjs)

Question 19

sodium valproate se

Answer 19

rash, sjs/ten

high dose: GI, decreased platelet count, pancreatitis, nausea

weight gain

Question 20

sodium valp target range

Answer 20

50-125 mcg/mL

Question 21

cbz moa

Answer 21

upregulates glutamate transport, blocking voltage sensitive Na+ channels

Question 22

cbz se

Answer 22

sjs/tens
gi, cns
reduced sodium, white blood count, blood dyscrasias

Question 23

target levels of cbz

Answer 23

4-12mcg/mL in 4w

Question 24

cbz ddi

Answer 24

clozapine -> agranulocytosis

Question 25

cbz pk

Answer 25

autoinduction, induces 1a2, 2c9/10, 3a3/4

Question 26

pregnancy first line

Answer 26

lamotrigine

Question 27

lamotrigine moa

Answer 27

blocks voltage sensitive Na+ and Ca+ channels

Question 28

lamotrigine se

Answer 28

rash, sjs

Question 29

lamotrigine benefit

Answer 29

less sedation and weight gain

Question 30

lamotrigine ddi ci

Answer 30

valp (sjs risk)

Question 31

lithium safe for liver patients?

Answer 31

yes, 100% cleared by kidneys

Question 32

how to tdm for lithium

Answer 32

take samples 12hrs after previous dose, 5-7 days after initiation/changes

Question 33

how to tdm for sodium valproate

Answer 33

trough sample, at least 2-3 days after initiation

Question 34

how to tdm for carbamazepine

Answer 34

trough sample needed, take 2-4 weeks to reach steady state. After 4 weeks: steady state achieved after 3-5d (dose adjust)

Question 35

lamotrigine how to titrate

Answer 35

2 week intervals