Chapter 65: Bipolar Disorder

Question 1

Bipolar I definition

Answer 1

at least one episode of mania, and usually, bouts of intense depression

Question 2

Mania is associated with at least one of the following:

Answer 2

significant impairment in social/work functioning, psychosis/delusions or requires hospitalization

Question 3

Bipolar II definition

Answer 3

at least one episode of hypomania (lasting > 4 consecutive days) and at least one depressive episode (lasting > 2 weeks)

Question 4

Antidepressants can induce or exacerbate a manic episode when used as monotherapy, so they should only be used when

Answer 4

in combination with a mood stabilizer (i.e., lithium or antiepileptic drugs like valproate, lamotrigine, and carbamazepine)

Question 5

First-line treatment for a manic episode

Answer 5

valproate, lithium or an antipsychotic

Question 6

First-line treatment for a depressive episode & an alternative

Answer 6

Lithium

Lamotrigine can be used as an alternative

Question 7

What are the preferred maintenance monotherapy for bipolar disorder

Answer 7

Lithium and valproate

Question 8

MedGuides are required with all antidepressants (primarily d/t ____) and with all antipsychotics (primarily d/t increased risk of ____ in elderly patients with dementia-related psychosis

Answer 8

suicide risk

risk of death

Question 9

Valproate exposure in pregnancy can increase the risk of fetal anomalies, including neural tube defects, fetal valproate syndrome and long-term adverse ____. Avoid in pregnancy, if possible, especially during the first trimester

Answer 9

cognitive effects

Question 10

Carbamazepine exposure in pregnancy can cause fetal carbamazepine syndrome, which can result in _____ and other significant issues. Avoid in pregnancy, if possible, especially during the first trimester

Answer 10

facial abnormalities

Question 11

Lithium exposure in pregnancy can cause an increase in ______ and other abnormalities

Answer 11

congenital cardiac malformations

Question 12

During pregnancy, ______ is a safer option relative to the other mood stabilizers. _______ has the most favorable safety profile in pregnancy, but its use is limited since it is only approved for bipolar depression

Answer 12

lamotrigine

Lurasidone

Question 13

Several anticonvulsants are used for the treatment of bipolar disorder, including

Answer 13

Lamotrigine, Valproate, Carbamazepine

Question 14

A major concern with antipsychotics is the risk of EPS. Which generation of antipsychotics have a higher incidence of EPS

Answer 14

First generation (e.g., haloperidol)

Question 15

Lithium brand name

Answer 15

Lithobid

Question 16

Therapeutic range of lithium

Answer 16

0.6-1.2 mEq/L (trough level)

Question 17

Warnings of Lithium

Answer 17

serotonin syndrome, renal impairment, hyponatremia and dehydration

Question 18

Lithium SE when within therapeutic range

Answer 18

GI upset, cognitive effects, cogwheel rigidity, tremor, thirst, polyuria/polydipsia, weight gain, hypothyroidism

Question 19

Lithium SE when in toxic range (> 1.5 mEq/L)

Answer 19

ataxia, coarse hand tremor, vomiting

Question 20

Lithium SE when in toxic range (> 2.5 mEq/L)

Answer 20

CNS depression, arrhythmia, seizure, coma

Question 21

Lithium monitoring

Answer 21

lithium levels, renal function, thyroid function

Question 22

How is lithium cleared?

Answer 22

Renally

Question 23

Can lithium be used in pregnancy?

Answer 23

No - associated with cardiac malformations in the first trimester

Question 24

Lithium levels increase with:

Answer 24

↓ salt intake, sodium loss (e.g., with ACEi, ARBs, thiazide diuretics)

Question 25

Lithium levels decrease with:

Answer 25

↑ salt intake, caffeine and theophylline

Question 26

There is an ↑ risk of serotonin syndrome if Li is taken with

Answer 26

SSRIs, SNRIs, triptans, linezolid, and other serotonergic drugs

Question 27

__ mL of lithium citrate syrup = __ mEq of lithium ion

Answer 27

5

8

Question 28

__ mEq of lithium ion = __ mg lithium carbonate tabs/caps

Answer 28

8

300

Question 29

T/F: Lithium should be taken with food

Answer 29

True