Bipolar/Psychosis

Question 1

Which drug is the most effective long term therapy for bipolar, protection against depression + mania, and decreases risk of suicide/short term mortality?

Answer 1

Lithium

Question 2

When dosing lithium, what should you do?

Answer 2

Start low and titrate up, then monitor the patient’s levels

Question 3

What are some things we must monitor when a patient is on lithium?

Answer 3

Pregnancy test Renal fxn Thyroid fxn Weight

Question 4

Your patient is going to begin lithium for their bipolar diagnosis. What ADRs must you tell them about?

Answer 4

GI issues, nausea, fatigue

Tremor

Weight gain

Polyuria/polydipsia

Hypothyroidism

Question 5

Why is it important to do a pregnancy test for a patient on lithium?

Answer 5

Teratogenic Associated with Ebstein’s anomaly

Question 6

Chlorpromazine and Thioridazine are what type of drugs?

Answer 6

1st gen anti-psychotics (low potency)

Question 7

Which 1st gen anti-psychotic is good for treating intractable hiccups?

Answer 7

Chlorpromazine

Question 8

Haloperidol is what type of drug?

Answer 8

1st gen anti-psychotic

Question 9

Which 1st gen anti-psychotic would help for emergency sedation of a severely agitated or delirious patient?

Answer 9

Haloperidol

Question 10

What class is perphenazine in?

Answer 10

1st gen anti-psychotic

Question 11

What class is fluphenazine in?

Answer 11

1st gen anti-psychotic

Question 12

What class is loxapine in?

Answer 12

1st gen anti-psychotic

Question 13

What class is molindone in?

Answer 13

1st gen anti-psychotic

Question 14

What class is thiothixene in?

Answer 14

1st gen anti-psychotic

Question 15

What class is trifluoperazine in?

Answer 15

1st gen anti-psychotic

Question 16

What are the major ADRs associated with 1st gen anti-psychotics?

Answer 16

EPS - tardive dyskinesia

NMS

Postural hypotension

Sedation

QTc prolongation

Increased prolactin

Question 17

What is beneficial for 2nd gen anti-psychotics in comparison to 1st gen anti-psychotics?

Answer 17

Less risk of EPS

Question 18

Which 2nd gen anti-psychotic is the most effective and used for refractory schizophrenia?

Answer 18

Clozapine

Question 19

What class is risperidone in?

Answer 19

Atypical Anti-psychotics (2nd gen)

Question 20

What class is olanzapine in?

Answer 20

Atypical Anti-psychotics (2nd gen)

Question 21

What class is quetiapine in?

Answer 21

Atypical Anti-psychotics (2nd gen)

Question 22

What class is ziprasidone in?

Answer 22

Atypical Anti-psychotics (2nd gen)

Question 23

What class is paliperidone in?

Answer 23

Atypical Anti-psychotics (2nd gen)

Question 24

What class is asenapine in?

Answer 24

Atypical Anti-psychotics (2nd gen)

Question 25

What class is Iloperidone in?

Answer 25

Atypical Anti-psychotics (2nd gen)

Question 26

What class is lurasidone in?

Answer 26

Atypical Anti-psychotics (2nd gen)

Question 27

What class is cariprazine in?

Answer 27

Atypical Anti-psychotics (2nd gen)

Question 28

What class is brexpiprazole in?

Answer 28

Atypical Anti-psychotics (2nd gen)

Question 29

What class is aripiprazole in?

Answer 29

Atypical Anti-psychotics (2nd gen)

Question 30

Black box warning for Atypical Anti-psychotics (2nd gen)

Answer 30

Increased mortality risk in dementia-related psychosis and suicidality for depression

Question 31

If you are a primary care PA who thinks your patient would benefit from a 2nd gen anti-psychotic, what should you do?

Answer 31

Refer to psych

Question 32

Who should you avoid 2nd gen anti-psychotics in?

Answer 32

Dementia patients Children

Question 33

If you want to take your patient off Clozapine, how would you do that?

Answer 33

Taper by 50% q2weeks

Question 34

Your patient who is taking a 2nd gen anti-psychotic for their schizophrenia is here for a routine visit. What PE/labs must you do

Answer 34

Weight check (ass with weight gain) Fasting lipid panel (ass with dyslipidemia) Fasting blood glucose/HgA1c (ass with DM)

Question 35

Which 2nd gen anti-psychotic is associated with DM and worse weight gain?

Answer 35

Olanzapine

Question 36

Which 2 second gen anti-psychotics are associated with worse QTc prolongation?

Answer 36

Iloperidone and ziprasidone

Question 37

Which 2nd gen anti-psychotic is associated with anaphylaxis and angioedema?

Answer 37

Asenapine

Question 38

Which 2nd gen anti-psychotic is associated with compulsive urges?

Answer 38

Aripiprazole

Question 39

Which two 2nd gen anti-psychotics are associated with DRESS?

Answer 39

Olanzapine and ziprasidone

Question 40

What are the ADRs for Clozapine?

Answer 40

DM Wt gain QTc prolongation Seizure risk GI hypomotility (toxic megacolon) Myocarditis Agranulocytosis

Question 41

What is the typical regimen for acute mania when severe?

Answer 41

Atypical anti-psychotic + Li or Valproate Hospitalize the patient

Question 42

What is the typical regimen for acute bipolar psychosis?

Answer 42

Li or atypical antipsychotics (cariprazine, lurasidone, olanzapine with fluoxetine)

Question 43

What is the typical regimen for less severe acute mania?

Answer 43

Monotherapy: Lithium, valporate, or atypical anti-psychotic

Question 44

What is the typical maintenance therapy for mania?

Answer 44

Lithium

Question 45

What is the typical maintenance therapy for depression?

Answer 45

Lamotrigine

Question 46

What is the maintenance therapy for mania and depression?

Answer 46

Lithium alone, or with valproate, CBZ, lamotrigine, or atypical anti-psychotic

Question 47

What is the irreversible EPS common with anti-psychotics?

Answer 47

Tardive dyskinesia