Therapeutics of Bipolar Disorder

Lithium orotate is the same as lithobid

Combo therapy should never be used with lithium and valproate

Age of onset for bipolar disorder

Which of the following is true about valproate (Depakote)

Lithium (Lithobid) follows linear kinetics

Most common mood pole experienced

Significant periods of ~2 years of hypomanic & depressive symptoms, that never meet full criteria for the 3 episodes

Serotonergic antidepressants can be used to treat anxiety in bipolar disorder along with maintenance mood stabilizer

Which of the following is 1st line pharmacotherapy for acute mania bipolar disorder

Which of the following is true about mood cycles in bipolar disorder

When treating bipolar disorder which of the following is usually tried first

Which of the following is 1st line pharmacotherapy for acute depression bipolar disorder

Hemodialysis is recommended with >4 mEq/L or >2.5 mEq/L with serious symptoms of lithium toxicity

Characterized by 4 or more mood episodes in 1 year

Hypomania is a less severe form of mania

Onset of action is delayed due to slow dose titration

Which of the following is later line pharmacotherapy for acute mania bipolar disorder

Suicide attempts are high in both poles of bipolar disorder

Anxiety disorders are a common comorbidity in bipolar disorder

Neurologic changes, coma are which level toxicities

Which of the following is a non-pharmacologic treatment for bipolar disorder

Symptoms include distractibility, irritability, grandiosity, flight of ideas, agitation, decreased sleep, talkativeness

Which of the following is later line pharmacotherapy for acute depression bipolar disorder

Which atypical antipsychotic is not FDA-approved for acute and/or maintenace treatment with and without psychosis

Maintenance antidepressant therapy before adding a mood stabilizer is best practice for bipolar disorder

1 or more episodes of mania for 1 week or requiring hospitalization, depressive/hypomanic episodes may have occurred

Valproate (Depakote) has a boxed warning for

Diagnositc criteria are the same for MDD

Valproate (Depakote) may need to be increased when changing to ER from another formulation

Hospitalization is often not required and psychotic features are uncommon

Which of the following should be monitored when taking lithium (Lithobid)

Lithium should be drawn trough serum concentation 72 hrs after stable dosing (5 days), including 12 hrs after last dose

Hospitalization is generally required, and severe episodes may involve psychosis

Which of the following are side effects of Lithium (Lithobid)

Ataxia, blurred vision, tinnitus, ECG changes are which level toxicities

All of the following are true about lithium (Lithobid) except

Use of antidepressants is linked with a switch to mania

Major depressive and hypomanic episdoes, no episodes of mania

Valproate (Depakote) has a boxed warning for hepatotocicity for only the 1st 6 months of treatment

ACEi, ARBs, thiazide diuretics, NSAIDs, dehydration

Which of the following are true about atypical antipsychotics in bipolar disorders

Olanzapine and clozapine are atypicals often used in pregnancy with bipolar disorder due to less teratogenic effects

Polyuria, thirst, fine hand tremor are which level toxicities

All of the following are true about lithium (Lithobid) except

Actue treatment levels of lithium are 0.9-1.2 mEq/L while maintenance levels are 0.6-0.9 mEq/L

Caffeine, osmotic diuretics, +/- loop diuretics

Abnormally and persistently elevated, expansive or irritable mood

Sodium bicarbonate, high Na intake

Lithium (Lithobid) is teratogenic & should be avoided in 1st trimester however it can be used with caution in 2nd & 3rd

Not FDA-approved, but some literature supports its use in acute mania

Activated charcoal is a treatment option for lithium toxicity

Serum concentrations do not correlate well with efficacy in bipolar disorder, routine monitoring not necessary

Diarrhea, vomiting, drowsiness, muscle weakness, decreased coordination are which level toxicities

Which of the following is true about valproate (Depakote)

Which of the following is true about bipolar disorder

Symptoms include inflated self esteem, decreased need for sleep, distractibility

All of the following are true about lithium (Lithobid) except