Bipolar disorder

Question 1

Bipolar I

Answer 1

severe mania. may have psychosis

Question 2

Bipolar II

Answer 2

Hypomania. No psychosis

Question 3

Acute treatment

Answer 3

Maniac state: valproate or lithium + antipsychotic.

Depression State: Lithium or lamotrigine. Lurasidone or Symbyax (olanz/fluox) may also be used.

Question 4

Maintenance

Answer 4

Lamotrigine (Requires slow titration d/t risk of severe rash)
Lithium (with or without SGA).

Question 5

Preferred agent in pregnancy

Answer 5

Lurasidone (only helps with bipolar depression) preferred. SGA and Lamotrogiene is safer than other choices.

Question 6

Lithium therapeutic range

Answer 6

0.6 to 1/2 mEQ/L trough level. May go up to 1.5 in acute mania.

Question 7

BBW of lithium

Answer 7

lithium toxicity

Question 8

Lithium SEs

Answer 8

GI upset, polyuria/polydipsia,
Anorexia, weight gain, edema,
cogwheel rigidity, hand tremor,
hypothyroidism, cardiac abnormalities (inverted T waves)

Question 9

Lithium toxicity at > 1.5 mEq/L

Answer 9

Coarse hand tremor, vomiting, persistent diarrhea, confusion, ataxia (impaired coordination)

Question 10

Lithium toxicity at > 2.5 mEq/L

Answer 10

CNS depression, seizures, irreversible brain demange, coma, arrhythmia

Question 11

Lithium level increases with

Answer 11

decreased salt intake, sodium loss (w/ ACE/ARBs, thiazide diuretics), NSAIDs

Question 12

Lithium level decreases with

Answer 12

increased salt intake, caffeine and theophylline

Question 13

Increases risk of neurotoxicity when lithium is taken with

Answer 13

verapamil, diltiazem, phenytoin, and carbamazepine.