Mood Stabilizers

Question 1

What is the gold standard medication for bipolar disorder?

Answer 1

Lithium

Question 2

What are the therapeutic serum levels for lithium in acute mania?

Answer 2

0.8–1.2 mEq/L

Question 3

What are the therapeutic levels for lithium in maintenance therapy?

Answer 3

0.6–1.0 mEq/L

Question 4

What must you monitor regularly in a patient taking lithium?

Answer 4

Renal function, thyroid function, lithium level, electrolytes

Question 5

What are the early signs of lithium toxicity?

Answer 5

Nausea, vomiting, diarrhea, tremor, thirst, polyuria

Question 6

What are the late signs of lithium toxicity?

Answer 6

Confusion, ataxia, seizures, coma

Question 7

What is the mnemonic for lithium side effects?

Answer 7

LITH — Leukocytosis, Insipidus (diabetes insipidus), Tremor, Hypothyroidism

Question 8

Which two major organ systems does lithium impact?

Answer 8

Kidneys and thyroid

Question 9

Name three major drug interactions that increase lithium levels.

Answer 9

NSAIDs, thiazide diuretics, ACE inhibitors

Question 10

Which mood stabilizer is most associated with neural tube defects in pregnancy?

Answer 10

Valproate (Depakote)

Question 11

What labs should you monitor for valproate use?

Answer 11

LFTs, CBC (platelets), valproate levels

Question 12

What are common side effects of valproate?

Answer 12

Weight gain, GI upset, tremor, hepatotoxicity, thrombocytopenia

Question 13

Which mood stabilizer can cause Stevens-Johnson syndrome, especially when started too fast?

Answer 13

Lamotrigine (Lamictal)

Question 14

How do you safely start lamotrigine to prevent rash?

Answer 14

Titrate slowly over weeks

Question 15

What is a unique benefit of lamotrigine for bipolar disorder?

Answer 15

Strong efficacy in bipolar depression (vs mania)

Question 16

What’s the biggest safety concern when combining lamotrigine with valproate?

Answer 16

Increased risk of severe rash (valproate raises lamotrigine levels)

Question 17

Which mood stabilizer is associated with hyponatremia and autoinduction of metabolism?

Answer 17

Carbamazepine (Tegretol)

Question 18

What labs should be monitored for carbamazepine?

Answer 18

CBC, LFTs, sodium levels, carbamazepine levels

Question 19

What genetic test is recommended before prescribing carbamazepine to Asian patients?

Answer 19

HLA-B*1502 allele (risk of Stevens-Johnson syndrome)

Question 20

Which mood stabilizers are anticonvulsants used off-label for bipolar disorder?

Answer 20

Valproate, lamotrigine, carbamazepine

Question 21

Which mood stabilizer has the highest teratogenic risk?

Answer 21

Valproate (neural tube defects, cognitive issues)

Question 22

Which mood stabilizer is safest in pregnancy (if one must be used)?

Answer 22

Lamotrigine (category C, but generally safer than others)

Question 23

What is the brand name for lithium?

Answer 23

Lithobid

Question 24

What is the generic name for Lithobid?

Answer 24

Lithium

Question 25

What is the brand name for valproate?

Answer 25

Depakote

Question 26

What is the generic name for Depakote?

Answer 26

Valproate (or divalproex sodium)

Question 27

What is the brand name for lamotrigine?

Answer 27

Lamictal

Question 28

What is the generic name for Lamictal?

Answer 28

Lamotrigine

Question 29

What is the brand name for carbamazepine?

Answer 29

Tegretol

Question 30

What is the generic name for Tegretol?

Answer 30

Carbamazepine

Question 31

What are the 4 primary classes of mood stabilizers?

Answer 31

1. Lithium 2. Anticonvulsants (e.g., valproate, carbamazepine, lamotrigine) 3. Atypical antipsychotics (used adjunctively) 4. Calcium channel blockers (rare, off-label)

Question 32

Name 5 commonly used mood stabilizers.

Answer 32

• Lithium (Lithobid) • Valproate (Depakote) • Lamotrigine (Lamictal) • Carbamazepine (Tegretol) • Oxcarbazepine (Trileptal – off-label use)

Question 33

Which atypical antipsychotics have FDA approval for mood stabilization in bipolar disorder?

Answer 33

• Quetiapine (Seroquel) • Aripiprazole (Abilify) • Lurasidone (Latuda – for bipolar depression) • Olanzapine (Zyprexa) • Risperidone (Risperdal)

Question 34

Which mood stabilizer is most effective at preventing suicide in bipolar disorder?

Answer 34

Lithium

Question 35

Which mood stabilizers are most effective for treating bipolar depression?

Answer 35

Lamotrigine (Lamictal) and lurasidone (Latuda)

Question 36

Which two mood stabilizers are most teratogenic?

Answer 36

Valproate (Depakote) and carbamazepine (Tegretol)

Question 37

Which mood stabilizer is rarely used but sometimes considered when others fail?

Answer 37

Oxcarbazepine (Trileptal)