Mood Stabilizers

Question 1

What are the indications for mood stabilizers?

Answer 1

bipolar, cyclothymia, schizoaffective, impulse control, intermittent explosive disorders

Question 2

What are the three classes of mood stabilizers?

Answer 2

lithium
anticonvulsants
antipsychotics

Question 3

What is the only mood stabilizing medication proved to reduce suicide rates?

Answer 3

lithium

Question 4

What are three factors that predict good response to lithium?

Answer 4

prior success/family history
classic pure mania
mania followed by depression

Question 5

What are three tests to attain prior to starting lithium?

Answer 5

baseline creatinine
TSH
CBC

Question 6

During the first trimester, lithium is associated with increased risk of ____________ in pregnancy

Answer 6

ebstein’s anomaly

Question 7

This drug may cause polyuria or polydypsia secondary to ADH antagonisms

Answer 7

lithium

Question 8

What are the AE seen with mild lithium toxicity?

Answer 8

vomiting
diarrhea
ataxia
dizziness
slurred speech
nystagmus

Question 9

What are the AE seen with moderate lithium toxicity?

Answer 9

n/v anorexia
blurred vision, clonic limb movements
convulsions, delirium, syncope

Question 10

What are the AE seen with severe lithium toxicity?

Answer 10

generalized convulsions

oliguria and renal failure

Question 11

What three drugs have FDA approval for adjunct therapy not mono therapy?

Answer 11

quetiapine (and XR)

ziprasidone

Question 12

What drug would be a good choice for a pt who is a rapid cycler w/a h/o ETOH abuse?

Answer 12

depakote

Question 13

When is it time to decreased a dose d/t increases in LFTs

Answer 13

When they triple thier baseline

Question 14

What is the MOA of typical antipsychotics?

Answer 14

D2 dopamine receptor antagonists

Question 15

Low potency typical antipsychotics interact with ______________ receptors

Answer 15

nondopaminergic

Question 16

Low potency typical antipsychotics have more ___________ and ___________ adverse effects

Answer 16

cardiotoxic

anticholinergic

Question 17

What kind of drug are chlorpromazine and thioridazine?

Answer 17

low potency typicals

Question 18

What kind of drug is fluphenazine?

Answer 18

typical antipsychotic

Question 19

What kind of drug is haloperidol?

Answer 19

typical antipsychotic

Question 20

What kind of drug is pimozide?

Answer 20

typical antipsychotic

Question 21

MOA of atypical antipsychotics

Answer 21

serotonin-dopamine 2 antagonists (SDAs)

Question 22

What makes the atypical antipsychotics, atypical?

Answer 22

they affect dopamine and serotonin neurotransmission in the four key dopamine pathways in the brain

Question 23

At doses greater than 6 mg, risperidone acts as a ___________ antipsychotic

Answer 23

typical

Question 24

What is the drug most likely to cause hyperprolactinemia?

Answer 24

risperidone

Question 25

With what drug may you see weight gains up to 30-50 lbs?

Answer 25

olanzapine

Question 26

What is the drug most likely to cause orthostatic hypotension?

Answer 26

quetiapine

Question 27

What drug causes significant QT prolongation in susceptible patients?

Answer 27

ziprasidone

Question 28

Ziprasidone _______________ cause weight gain

Answer 28

does not

Question 29

Absorption of ziprasidone is ________ with food

Answer 29

increased

Question 30

What is the unique MOA of aripiprazole?

Answer 30

D2 partial agonist

Question 31

What drug can cause potential intolerability d/t akathisia/activation

Answer 31

aripiprazole

Question 32

This drug is reserved for patients refractory to other treatments d/t its side effects

Answer 32

clozapine

Question 33

This drug is associated with agranulocytosis and therefore requires regular blood draws

Answer 33

clozapine

Question 34

What drug is associated with the most sedation, weight gain and transaminitis?

Answer 34

clozapine

Question 35

What drug REQUIRES bid dosing

Answer 35

iloperidone | asenapine

Question 36

This drug must be titrated over 4 days to 12 mg in order to minimize the risk of orthostatic hypotension

Answer 36

iloperidone

Question 37

_________ are inhibitors of 3A4 (ketoconazole) or 2D6 (fluoxetine, paroxetine)

Answer 37

iloperidone

Question 38

This drug is given sublingually

Answer 38

asenapine

Question 39

Asenapine is a ___________ inhibitor

Answer 39

CYP1A2

Question 40

What drugs can you use to prevent extrapyramidal side effects of antipsychotics?

Answer 40

anticholinergics bentropine trihexyphenidyl diphenhydramine

Question 41

What two drugs would in contraindicated in a patient with elevated total cholesterol and low HDL?

Answer 41

olanzapine | quetiapine

Question 42

in anxiety disorders, you often use ___________ with SSRIs or SNRIs

Answer 42

anxiolytics

Question 43

MOA of buspirone

Answer 43

5HT1A agonists

Question 44

This drug will not reduce anxiety in patients that are use to taking BZDs because there is no sedation effect

Answer 44

buspirone

Question 45

This type of drug is often used for CNS deperssant w/d protocols and ETOH w/d

Answer 45

benzodiazapines

Question 46

Which benzo has the shortest half life?

Answer 46

triazolam (2-3 hours)

Question 47

Which benzo has the longest half life?

Answer 47

flurazepam (40-100 hours)