Somatic Therapies III

Question 1

What are the two drugs approved for bipolar maintenance?

Answer 1

• Li

- Lamotrigine

Question 2

What are the three drugs that are helpful for the depressive stage of bipolar disorder?

Answer 2

• Olanzapine
• Quetiapine
• Lurasidone

Question 3

What is the onset of action of Li?

Answer 3

5-7 days

Question 4

What organ metabolizes Li?

Answer 4

Renal

Question 5

What is the WBC abnormality that can occur with Li use?

Answer 5

Demarginalization causing leukocytosis

Question 6

True or false: Li is rapidly absorbed

Answer 6

True

Question 7

What are the pharmacokinetics of Li?

Answer 7

Linear

Question 8

What are the side effects of Li?

Answer 8

• Polyuria/polydipsia
• Acne
• Hypothyroidism

Question 9

How often should Li levels be checked?

Answer 9

Monthly for 3 months, then q 3 months

Question 10

What are the drugs that increase Li levels?

Answer 10

Na depleting diuretics

Question 11

Where is Li reabsorbed in the kidney?

Answer 11

Proximal tubule

Question 12

Long term use of Li can increase what lyte level?

Answer 12

Ca

Question 13

What are the cognitive side effects of Li?

Answer 13

• Distractibility
• poor memory
• Confusion

Question 14

What are the congenital effects of Li?

Answer 14

Ebstein cardiac anomaly

Question 15

When does Li toxicity come into play?

Answer 15

1.5 levels and above

Question 16

What is the treatment for Li toxicity?

Answer 16

Dialysis

Question 17

When is divalproex used for bipolar?

Answer 17

Rapid cyclers

Question 18

What is the MOA of divalproex?

Answer 18

Increase GABA by inhibiting degradation and stimulating synthesis

Question 19

What organ metabolizes divalproex? What are the labs that are monitored?

Answer 19

• Hepatic

- LFTs, CBC

Question 20

What are the teratogenic effects of divalproex?

Answer 20

NTDs

Question 21

What are the side effects of divalproex?

Answer 21

• Toxic hepatitis
• Hair loss
• PCOS

Question 22

What are the effects of divalproex in prego?

Answer 22

NTDs

Question 23

What is the MOA and use of carbamazepine?

Answer 23

• Acute mania and bipolar

- Na channel blocker and GABA agonist

Question 24

What is the major side effect of carbamazepine?

Answer 24

Aplastic anemia

Question 25

What is the MOA and use of lamotrigine?

Answer 25

- Na channel blocker | - Seizures

Question 26

What is the major side effect of lamotrigine? What must be done to prevent this?

Answer 26

- Steven-Johnson syndrome | - Start slow and titrate up

Question 27

What is the role of topiramate and gabapentin in the treatment of bipolar disorder?

Answer 27

No evidence of efficacy

Question 28

What are the three major first line drugs in the treatment of Bipolar disorder?

Answer 28

Li Valproate Lamotrigine

Question 29

What is the role of SGAs in the treatment of bipolar disorder?

Answer 29

second line

Question 30

What is considered an adequate trial of Li, valproate, or lamotrigine?

Answer 30

3-4 weeks

Question 31

What is the second line treatment for Bipolar?

Answer 31

Anticonvulsant + Li or SGAs + Li

Question 32

True or false: most Bipolar DOs need only one drug

Answer 32

False--need 2+

Question 33

What is the role of ECT for bipolar disorder?

Answer 33

Refractory dz

Question 34

How hard to treat is depression with bipolar disorder, relative to MDD? Mania?

Answer 34

Depression is Much harder, but mania relatively easy

Question 35

What is the difference between bipolar I and II?

Answer 35

``` I = classic II = hypomania ```

Question 36

If you have a pt with refractory depression, what should always be suspected?

Answer 36

Bipolar

Question 37

True or false: most of the time, bipolar patients are either euthymic, or depressed, but rarely manic

Answer 37

True

Question 38

What is the thinking of the MOA of ECT?

Answer 38

downregulate beta-receptors

Question 39

What has the highest success rate for depression?

Answer 39

ECT

Question 40

What are the three major indications for ECT?

Answer 40

- Refractory depression - Severe suicidal ideation - Depression + refusal to eat/drink

Question 41

How many treatments are needed for ECT?

Answer 41

6-12 weeks, with 3 treatments per week

Question 42

What is the role of atropine in ECT?

Answer 42

- Prevent bradyarrhythmias | - Reduce secretions

Question 43

What are the adverse effects of ECT?

Answer 43

- Fractures d/t muscle relaxant - Postictal confusion - Memory impairment

Question 44

What is the effect of ECT on anterograde memory?

Answer 44

Minimal evidence that it affects it

Question 45

What are the two meds for ADHD?

Answer 45

- Methylphenidate (ritalin) | - Dextroamphetamine (adderall)

Question 46

What is the MOA of clonidine?

Answer 46

Alpha-2 agonism

Question 47

What are the side effects of stimulants?

Answer 47

- Anorexia - Emotional lability - Tics

Question 48

What are the CV effects of stimulants?

Answer 48

- Increased HR | - Sudden death

Question 49

What are the usual hallucinations with stimulant use?

Answer 49

Feeling bugs on their skin

Question 50

What is the general MOA of stimulants?

Answer 50

-Blockade of NE and dopamine reuptake

Question 51

What is the major problem with stimulants use and ADHD?

Answer 51

Physicians keep increasing the dose to treat multiple, comorbid ADHD issues

Question 52

When are stimulants used in depression?

Answer 52

Treat persistent anergia or amotivation

Question 53

Is it ethical to prescribe stimulants for neuroenhancement?

Answer 53

Yes, but insurance will not cover it

Question 54

What is the MOA and use of atomoxetine? Risks/benefits?

Answer 54

NE reuptake inhibitor to treat ADHD--lower side effects, longer effect but less efficacious

Question 55

True or false: age and weight are good predictors for dosing stimulants

Answer 55

False

Question 56

What is the MOA of guanfacine?

Answer 56

Alpha-2 agonist

Question 57

What are the contraindications for ECT?

Answer 57

- Heart issues | - Increased ICP or space occupying brain lesion