Bipolar disorder

Question 1

Which antipsychotics are recommended in the treatment of acute mania?

Answer 1

Risperidone, olanzapine, haloperidol, quetiapine

Question 2

Describe Olanzapine’s licensing in bipolar disorder

Answer 2

Licensed for long-term prophylaxis of mania in patient’s whose mania has previously responded to it.

Question 3

What class of drugs should ALWAYS be stopped in acute mania/hypomania?

Answer 3

anti-depressants as can worsen mania

Question 4

When should antidepressants be avoided in bipolar disorder?

Answer 4

Anyone with a recent episode of hypomania, rapid-cycling bipolar, recent functionally impairing mood fluctuations.

Question 5

Why is lithium not used in severe mania first-line?

Answer 5

Delayed response of 10-14 days

Question 6

When should benzodiazepines be considered in bipolar disorder?

Answer 6

If agitated in the initial stages of mania

Question 7

Which anti-epileptic drugs AREN’T recommended for acute mania?

Answer 7

Carbamazepine and lamotrigine due to their anti-depressant effects

Question 8

First line treatment for a mild, acute depressive episode in Bipolar?

Answer 8

Monitor and reassess in 2 weeks

Question 9

First-line treatment for a moderate to severe depressive episode in Bipolar?

Answer 9

Quetiapine or SSRI

Question 10

First-line treatment for a moderate to severe depressive episode in a patient with rapid-cycling bipolar disorder?

Answer 10

Increasing/ adding antimanic drug (including lamotrigine) as antidepressants can’t be used.

Question 11

How to does therapy change upon remission of a depressive episode in bipolar?

Answer 11

Gradually reduce antidepressant and continue anti-manic drug

Question 12

Which SSRI is preferred in the treatment of depressive episodes in bipolar disorder?

Answer 12

Fluoxetine

Question 13

When should long-term management be considered in bipolar disorder?

Answer 13

Patient has had:
- a manic episode with significant risk
- 2+ manic episodes in bipolar I
- frequent episodes, suicidal ideation, or severe functional impairment in bipolar II

Question 14

Which drugs and routes should be considered for rapid tranquilisation in bipolar disorder?

Answer 14

IM lorazepam, haloperidol, and olanzapine

Question 15

How is an acute mixed episode of bipolar disorder treated?

Answer 15

Treated the same as acute manic episode

Question 16

Describe place of therapy of carbamazepine in bipolar disorder

Answer 16

Used as long-term prophylaxis if lithium not tolerated or contra-indicated.

Question 17

What tests are required in the monitoring of lithium- and how often?

Answer 17

TFTs, calcium, U&Es + BMI every 6 months once stable

Question 18

How often should lithium levels be taken once therapy is stable?

Answer 18

Every 3 months

Question 19

What is the therapeutic serum levels for lithium?

Answer 19

0.6-1.0mmol/L

Question 20

Describe the symptoms most likely to be transient when being started on lithium therapy?

Answer 20

vomiting, diarrhoea, vertigo, muscle weakness, and dazed feeling

Question 21

What side effects of lithium are likely to persist?

Answer 21

polydipsia, polyuria, and fine hand tremors

Question 22

Describe the signs of lithium toxicity

Answer 22

diarrhoea, vomiting, anorexia, choreoathetoid movements, lethargy, muscle weakness, tremor of extremities and lower jaw, blurred vision + tinnitus

Question 23

Describe the longer term adverse effects associated with lithium

Answer 23

rhabdomyolysis, thyroid disorders, nephrotoxicity, renal tumours

Question 24

Which endocrine disorder is lithium contra-indicated in?

Answer 24

Addison’s disease

Question 25

Which cardiac disease is lithium contra-indicated in?

Answer 25

Brugada syndrome and cardiac disorders associated with rhythm disorders

Question 26

Which patient group may require lower doses of lithium?

Answer 26

The elderly

Question 27

Describe the effect of dapagliflozin on lithium levels

Answer 27

levels decrease due to increased clearance

Question 28

Which class of diuretics are particularly problematic when combined with lithium therapy?

Answer 28

thiazide and thiazide-like diuretics as they reduce clearance of lithium

Question 29

Why do NSAIDs interact with lithium?

Answer 29

As they effect fluid balance which effects lithium levels

Question 30

Describe the effect of ACE inhibitors on lithium levels

Answer 30

levels decrease- can cause lithium toxicity

Question 31

Which two drugs can cause neurotoxicity if used in combination with lithium?

Answer 31

Haloperidol and carbamazepine