Materials for Bipolar Disorder for DSM II

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mcucullu
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162154
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Materials for Bipolar Disorder for DSM II
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2012-07-11 20:03:06
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bipolar disorder disease state management II dsm drugs doses treatments signs
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These cards cover the drugs, doses, symptoms, signs, treatment, etc. for bipolar disorder.
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  1. What are some manic symptoms of bipolar disorder?
    • 1) decreased need for sleep
    • 2) elevated mood
    • 3) unusual irritability
    • 4) grandiosity
    • 5) increased sexual desire
    • 6) flight of ideas
  2. What are some depressive symptoms of bipolar disorder?
    • 1) depressed mood
    • 2) diminished interest/pleasure
    • 3) significant weight loss/gain
    • 4) decreased concentration
    • 5) suicidal ideation
    • 6) hypersomnia/insomnia
  3. Describe Bipolar I.
    • 1) more psychosis
    • 2) more likely to require hospitalization
    • 3) easier to treat
  4. Describe Bipolar II.
    • 1) more common in women
    • 2) difficult to treat
  5. What are some pharmacotherapeutic treatments for acute mania?
    • 1) lithium (Lithobid, Eskalith)
    • 2) valproate (Depakene, Stavzor, Depakote, Divalproex)
    • 3) SGA's - atypical antipsychotics
  6. What are some pharmacotherapeutic treatments for bipolar depression?
    • 1) lithium (Lithobid, Eskalith)
    • 2) aripiprazole (Abilify)
    • 3) quetiapine XR (Seroquel)
    • 4) lamotrigine (LaMICtal, LaMICtal ODT, LaMICtal XR)
  7. What pregnancy category is lithium (Lithobid, Eskalith)?
    Pregnancy Category D
  8. Define "pregnancy category D".
    Based on human data, the drug can cause fetal harm when administered to pregnant women, but the potential benefits from the use of the drug may be acceptable, despite its potential risks.
  9. How is lithium cleared?
    100% renally
  10. What is the therapeutic range for lithium?
    0.8 - 1.2 mEq/L (trough level)
  11. What must be monitored in patients taking lithium?
    • 1) BMP
    • 2) Renal function
    • 3) thyroid function
  12. Which drugs/dietary habits increase lithium levels?
    • 1) decreased salt intake
    • 2) NSAIDs
    • 3) ACEIs
    • 4) ARBs
    • 5) dehydration
    •   a. caution with diuretics
    • 6) metronidazole
  13. Which drugs/dietary habits decrease lithium levels?
    • 1) increased salt intake
    • 2) caffeine
    • 3) theophylline
  14. Which drugs increase the risk of 5HT-syndrome in concurrent therapy with lithium?
    • 1) SSRIs
    • 2) SNRIs
    • 3) triptans
    • 4) linesolid
    • 5) other serotonergic drugs
  15. What are the adverse effects associated with lithium?
    • 1) GI upset
    • 2) cognitive effects
    • 3) cogwheel rigidity
    • 4) fine hand tremor
    • 5) weight gain
    • 6) polyuria
    • 7) polydipsia
    • 8) hypothyroidism
  16. What toxicities may occur when serum lithium levels reach > 1.5 mEq/L?
    • 1) coarse hand tremor
    • 2) vomiting
    • 3) persistent diarrhea
    • 4) confusion
    • 5) ataxia
  17. What toxicities occur when serum lithium levels reach > 3 mEq/L?
    • 1) CNS depression
    • 2) arrhythmia
    • 3) seizures
    • 4) irreversible brain damage
    • 5) coma
    • 6) mortality
  18. In what pregnancy category is valproate/valproic acid (Depakene, Stavzor, Depakote, Divalproex)?
    Pregnancy category D
  19. What are the black box warnings for the use of valproate/valproic acid (Depakene, Stavzor, Depakote, Divalproex)?
    • 1) hepatic failure
    • 2) teratogenicity
    • 3) pancreatitis
  20. In what range should serum valproate/valproic acid (Depakene, Stavzor, Depakote, Divalproex) be kept?
    50 - 125 mcg/mL
  21. What are the adverse effects associated with valproate/valproic acid (Depakene, Stavzor, Depakote, Divalproex)?
    • 1) GI upset
    • 2) alopecia
    • 3) sedation
    • 4) tremor
    • 5) weight gain
    • 6) thrombocytopenia
  22. How is alopecia associated with valproate/valproic acid (Depakene, Depakote, Stavzor, Divalproex) use treated?
    • 1) selenium
    • 2) zinc
  23. What parameters are monitored while a patient is undergoing valproate/valproic acid (Depakote, Depakene, Stavzor, Divalproex) treatment?
    • 1) LFTs
    • 2) CBC
    • 3) platelets
  24. Can Depakote delayed release tablets be substituted by Depakote ER?
    No. If you want to switch to Depakote ER, the dose must be increased by 8-20%.
  25. What second-generation antipsychotics are used for the treatment of bipolar disorder?
    • 1) aripiprazole (Abilify)
    • 2) quetiapine extended-release (Seroquel XR)
    • 3) ziprasidone (Geodon)
    • 4) risperidone (Risperdal)
  26. What are the indications for aripiprazole (Abilify)?
    • 1) manic & mixed symptoms
    • 2) maintenance
  27. What is the dose for aripiprazole (Abilify)?
    15 - 30 mg QAM
  28. What are the adverse effects associated with aripiprazole (Abilify)?
    • 1) akathisia
    • 2) restlessness
    • 3) insomnia
    • 4) constipation
    • 5) fatigue
    • 6) blurred vision
  29. What are some adverse effects associated with all second-generation antipsychotics?
    • 1) dyslipidemia
    • 2) weight gain
    • 3) diabetes
    • 4) NMS
    • 5) TD
    • 6) leukopenia
    • 7) neutropenia
    • 8) agranulocytosis
    • 9) orthostasis/dizziness
  30. What are the indications for quetiapine extended release (Seroquel XR)?
    • Stand alone agent:
    • 1) bipolar depression
    • Concurrent use with lithium or Divalproex:
    • 1) mania
    • 2) maintenance
  31. What is the dose of quetiapine extended release (Seroquel XR) in the use for bipolar mania or maintenance?
    400 - 800 mg QHS
  32. What is the dose of quetiapine extended release (Seroquel XR) in the use for bipolar depression?
    300 mg QHS
  33. What are the adverse effects associated with quetiapine extended release (Seroquel XR)?
    • 1) sedation
    • 2) dry mouth
    • 3) constipation
    • 4) dizziness
    • 5) increased appetite
    • 6) weight gain
    • 7) nausea
  34. What are the indications for ziprasidone (Geodon)?
    • Stand alone agent:
    • 1) manic & mixed episodes
    • Concurrent use with lithium or valproate:
    • 1) maintenance
  35. What is the initial dose for ziprasidone (Geodon)?
    40 mg BID
  36. Up to what dose can you increase ziprasidone (Geodon) to?
    80 mg BID
  37. What are the adverse effects associated with use of ziprasidone (Geodon)?
    • 1) QT risk
    • 2) numbs mouth
    • 3) sedation
    • 4) dizziness
    • 5) weight gain
  38. What are the indications for the use of risperidone (Risperdal)?
    • Alone or with lithium or valproic acid:
    • 1) acute mania
    • 2) mixed episodes
  39. What is the initial dose for risperidone (Risperdal)?
    2 - 3 mg/day
  40. Up to what dose can risperidone (Risperdal) be given?
    6 mg
  41. What is the dose of risperidone (Risperdal) in children?
    1) 0.5 mg/day
  42. In what dosage forms is risperidone (Risperdal) available in?
    • 1) tablets
    • 2) oral solution
    • 3) M-tabs
  43. What are the adverse effects associated with risperidone (Risperdal)?
    • 1) sedation
    • 2) increased appetite
    • 3) fatigue
    • 4) insomnia
    • 5) parkinsonism
    • 6) akathisia
    • 7) nausea
    • 8) some QT risk
  44. What pregnancy category is lamotrigine (LaMICtal, LaMICtal ODT, LaMICtal CD, LaMICtal XR)?
    Pregnancy category C
  45. Define Pregnancy Category C.
    • 1) Animal reproduction studies have shown an adverse effect on the fetus.  There are no adequate and well-controlled studies in humans and the benefits from the use of the drug in pregnant women may be acceptable, despite its potential risks.
    • 2) Animal reproduction studies have not been conducted.
  46. What are the black box warnings for lamotrigine (LaMICtal, LaMICtal ODT, LaMICtal CD, LaMICtal XR)?
    • 1) Serious skin reactions
    • 2) SJS
    • 3) TEN
    • 4) increased risk with high starting doses
    • 5) rapid increases
    • 6) co-administration of valproic acids
    •   a. increases lamotrigine (LaMICtal, LaMICtal ODT, LaMICtal CD, LaMICtal XR) level by more than two-fold
  47. Define SJS.
    Stevens-Johnson Syndome: formation of purpuric macules and targetoid lesions. Full-thickness epidermal necrosis occurs, with lesser detachment of the cutaneous surface.  Drugs are the most common affiliant of this state, however it may be due to infection as well. The mortality rate is lower than the cases with TEN.
  48. Define TEN.
    Toxic epidermal necrolysis: is an acute disorder characterized by widespread erythematous macules and targetoid lesions.  Full-thickness epidermal necrosis occurs, and involves more than 30% of the cutaneous surface. The mucous membrane are commonly involved. The mortality rate is higher than in cases with SJS.
  49. What is a good strategy to use to decrease the risk of rash in patients taking lamotrigine (LaMICtal, LaMICtal ODT, LaMICtal CD, LaMICtal XR)?
    follow the titration schedule for the first five weeks
  50. What are the adverse effects associated with lamotrigine (LaMICtal, LaMICtal ODT, LaMICtal CD, LaMICtal XR)?
    • 1) diplopia
    • 2) sedation
    • 3) ataxia
    • 4) headache
  51. What are some inducers that increase lamotrigine (LaMICtal, LaMICtal ODT, LaMICtal CD, LaMICtal XR)?
    • 1) Divalproex
    • 2) Valproate (Depakete, Depakone, Stavzor)

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