L70- Ott bipolar

Question 1

3 common comorbidities with bipolar

Answer 1

alcoholism and substance use (50-60%)
+ anxiety

Question 2

manic episodes in bipolar I typically last how long?

Answer 2

at least 1 week

Question 3

hypomanic episodes in bipolar II generally last how long

Answer 3

4 or more days

Question 4

what types of drugs are the foundation of acute and maintenance treatment for bipolar disorders

Answer 4

mood stabilizers

Question 5

1st line for bipolar

Answer 5

lithium or valproic acid

Question 6

what can also be used as 1st line that isnt lithium or valproic acid?

Answer 6

atypicals as monotherapy or adjunct

Question 7

T or F: Lithium is associated with a decrease in suicidality

Answer 7

true

Question 8

what is the conversion ratio for liquid vs tab/cap forms of lithium?

Answer 8

1:1**

Question 9

IR lithium is associated with what

Answer 9

N/V

Question 10

CR lithium is associated with whta

Answer 10

diarrhea

Question 11

T or F: Lithium has a very wide therapeutic index

Answer 11

false, narrow af boi

Question 12

what serum level of lithium is considered to be approaching toxicity?

Answer 12

> 1.2-1.5 mEq/L

Question 13

Toxicities to monitor w/ lithium: (8 of them)(1 main one)

Answer 13

GI
ataxia
hypothyroidism *
polyuria
polydipsia
acne
dry mouth
weight gain
ecg changes

Question 14

considerations for lithium in pregnancy

Answer 14

avoid in 1st trimester bc of cardiac structural abnormality

Question 15

when to really consider ECG monitoring in lithiu

Answer 15

patient above 40

Question 16

how soon should a lithium level be collected after starting

Answer 16

72 hours

Question 17

what effect do aces/arbs/thiazides/NSAIDs have on lithium

Answer 17

decreased renal clearance (rise in Li levels)

Question 18

what effect do caffine/osmotic diuretics/loops have on lithium

Answer 18

increased renal clearance (decreased lithium levels)

Question 19

what effect does sodium bicarbonate have on lithium

Answer 19

increased lithium excretion (lower Li levels)

Question 20

which dosage form of valproic acid (valproate) do you see most often?

Answer 20

ER

Question 21

conversion for dosage forms of valproate

Answer 21

1:1

Question 22

T or F: ER form is 10-15% less bioavailable than DR form in valproate

Answer 22

true

Question 23

what dosage forms of valproic acid have a higher risk for GI ulcerations

Answer 23

syrup and capsule sprinkle form

Question 24

T or F: Use Valproate in caution in 2nd and 3rd trimester

Answer 24

false, dont use at all

Question 25

What bipolar drug causes PCOS in up to 50% of women?

Answer 25

valproic acid

Question 26

how might you treat PCOS due to valproic acid

Answer 26

metformin

Question 27

T or F: valproic acid is associated with weight gain

Answer 27

true

Question 28

drug that has adverse effect for hyperammonemia

Answer 28

valproic acid

Question 29

baseline monitoring for valproate (3)

Answer 29

pregnancy test, LFTs, CBC w/differential

Question 30

valproate has a sig concern with combo use of what other drug and for what reason

Answer 30

lamictal, SJS

Question 31

what are four other mood stabilizers that can be considered that arent the big ones

Answer 31

carbamazepine, oxcarbazepine, lamotrigine, topiramate

Question 32

associated w/ thrombocytopenia/ hematologic effects A. carbamazepine B. oxcarbazepine C. Lamotrigine D. topiramate

Answer 32

A

Question 33

associated with hyponatremia A. carbamazepine B. oxcarbazepine C. lamotrigine D. topiramate

Answer 33

b

Question 34

1st line for depressive sxs in bipolar A. carbamazepine B. oxcarbazepine C. lamotrigine D. topiramate

Answer 34

C

Question 35

NOT useful for acute tx or for manic episodes A. carbamazepine B. oxcarbazepine C. lamotrigine D. topiramate

Answer 35

C

Question 36

may cause weight loss A. carbamazepine B. oxcarbazepine C. lamotrigine D. topiramate

Answer 36

D

Question 37

heat intolerance/hypohidrosis A. carbamazepine B. oxcarbazepine C. lamotrigine D. topiramate

Answer 37

D

Question 38

metabolic acidosis and kidney stones A. carbamazepine B. oxcarbazepine C. lamotrigine D. topiramate

Answer 38

D

Question 39

possible teratogen - cardiac structural defects A. carbamazepine B. oxcarbazepine C. lamotrigine D. topiramate

Answer 39

D

Question 40

FDA-approved for bipolar depression – dose at least 300mg/day A. seroquel B. abilify C. Sybax (olanz/fluox) D. Lurasidone

Answer 40

A

Question 41

FDA-approved for adjunctive treatment in depression in combination with antidepressant treatment, may see increased use for bipolar depression A. seroquel B. abilify C. Sybax (olanz/fluox) D. Lurasidone

Answer 41

b

Question 42

FDA-approved for bipolar depression (just this) A. seroquel B. abilify C. Sybax (olanz/fluox) D. Lurasidone

Answer 42

D

Question 43

FDA-approved for bipolar depression and treatment-resistant depression A. seroquel B. abilify C. Sybax (olanz/fluox) D. Lurasidone

Answer 43

c

Question 44

what drug class is often used in pregnancy for bipolar?

Answer 44

atypicals, except olanzapine and clozapine