Bipolar DIsorder

Question 1

What is first line Tx for acute bipolar mania?

Answer 1

Lithium OR Divalproex OR AAP
OR
Combo: Lithium + AAP, or, Divalproex + AAP

Question 2

What is first line Tx for acute bipolar depression?

Answer 2

Lithium OR Lamotrigine OR Quetiapine
OR
Combo: Li + DVP, or, Li + LMTG, or Li + SSRI or NDRI, or DVP + SSRI or NDRI, or OLZ + SSRI
(do not use Paxil)

Question 3

When do you see a response to mood stabilizers in mania stage?

Answer 3

Some effect in 5-7 days, max effect in 2-3 weeks (this is the adequate trial period)

Question 4

When do you see a response to mood stabilizers in depression stage?

Answer 4

4-8 weeks (this is the adequate trial period)

Question 5

What drugs will you have therapeutic drug monitoring for?

Answer 5

Lithium, divalproex and carbamazepine.

Question 6

What are the early onset side effects of lithium?

Answer 6

Nausea, vomiting, diarrhea, polyuria, polydipsia

Question 7

What are the later onset side effects of lithium?

Answer 7

Fine hand tremor, nephrogenic diabetes insipidus, hypothyroidism, exacerbation of psoriasis and acne, and leukocytosis.

Question 8

How can you treat a fine hand tremor associated w/ Lithium?

Answer 8

Dose reduction, divide daily dose or propranolol bid

Question 9

What are situations that decrease lithium levels?

Answer 9

Pregnancy and theophylline.

Question 10

What are situations that increase lithium levels?

Answer 10

Diuretics, low Na diets, renal disease, excessive sweating, dehydration, CHF, protracted diarrhea, NSAIDs, ACEIs.

Question 11

What are the side effects of lamotrigine?

Answer 11

Headache, nausea, dry mouth, rash

Question 12

What are the treatment options of a benign rash caused by lamotrigine?

Answer 12

1. Reduce dose or hold current dose
2. Give antihistamine or topical corticosteroid for pruritus
3. Warn Pt is rash becomes worse

Question 13

What are the treatment options of a serious rash (SJS) caused by lamotrigine?

Answer 13

Stop lamotrigine. Monitor Pt closely for organ involvement.

Question 14

What are the side effects of Divalproex?

Answer 14

GI, cosmetic (hair thinning and weight gain), hematological, hepatic, pancreatitis, poly cystic ovarian syndrome, sedation, tremor

Question 15

What are the side effects of carbamazepine?

Answer 15

CNS (dizziness and drowsiness), GI (nausea, vomiting), hematological, hepatic, endocrine and dermatological.