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Front 1

FDA indications: Lithium

Back 1

mania associated w/ bipolar d/o

Front 2

Valproic acid

Back 2

-mania associated w/ bipolar d/o
-migraine prophylaxis
-epilepsy

Front 3

Carbamazepine

Back 3

-bipolar d/o (Equetro only)
-trigeminal neuralgia
-epilepsy

Front 4

Lamotrigine

Back 4

-long-term maintenance treatment of bipolar I d/o
-adjunctive treatment of partial szrs
-lennox-gastaut syndrome
-conversion to monotherapy in adults w/ partial szrs

Front 5

What types of patients may lithium be most effective in?

Back 5

1)pure mania
2)fewer prior epsodes
3)hx of euthymia
4)lacking neurological impariment
5)lacking psychotic sxs
6)no hx of substance abuse

Front 6

valproic acid may be most effective in what type of patients?

Back 6

1)rapid cyclers
2)mixed mania
3)mania due to medical conditions

Front 7

carbamazepine may be most effective in what type of patients?

Back 7

1)rapid cyclers
2)mixed episodes
3)neurological disease
4)negative FH of mood d/o

Front 8

lithium adverse effects (6)

Back 8

1)weight gain
2)leukocytosis
3)diabetes insipidus/polyuria
4)hypothyroidism
5)cardiac dysrhythmias
6)hand tremor

Front 9

VPA adverse effects (7)

Back 9

1)hepatotoxicity
2)pancreatitis
3)polycystic ovarian syndrome
4)thrombocytopenia
5)GI upset
6)sedation
7)weight gain

Front 10

carbamazepine adverse effects (9)

Back 10

1)aplastic anemia
2)agranulocytosis
3)thrombocytopenia
4)leukopenia
5)nystagmus 6)ataxia 7)blurry vision 8)stevens-johnson syndrome/rash
9)hyponatremia

Front 11

lamotrigine adverse effects (5)

Back 11

1)rash
2)tremor
3)dizziness
4)HA
5)sedation

Front 12

Lithium drug interactions

Back 12

increase lithium levels= ACEI, ARBs, diuretics, sodium depletion

decrease lithium levels= NaHCO3, NaCl, theophylline, caffeine

Front 13

this NSAID has little effect on lithium clearance

Back 13

aspirin

Front 14

this agent may increase risk of neurotoxicity when used with lithium

Back 14

haloperidol

Front 15

VPA drug interactions

Back 15

1)lamotrigine-decrease VPA levels, increase lamotrigine
2)warfarin-increase INR

Front 16

CBZ drug interactions

Back 16

decreases levels of:
1)oral contraceptives
2)anticoagulants
3)BZDs, bupropion, barbiturates
4)antipsychotics
5)anticonvulsants

Front 17

lamotrigine drug interactions

Back 17

1)valproic acid-inhibits metabolism of lamotrigine=may increase lamotrigine concentrations by 200%

Front 18

if taking VPA concurrently w/ lamotrigine, what dosing adjustment should be made?

Back 18

cut lamotrigine dose in 1/2 and titrate slowly to avoid rash

Front 19

Lithium drug monitoring

Back 19

1)upon initiation-level taken 12hrs after last dose q4-5d
2)lithium levels indicated 5-10d after dosing changes,etc.
3)baseline: thyroid function tests, renal function tests, CBC, electrolytes, weight, EKG
4)followup: serum drug levels, renal/thyroid function tests, wt, and CBC monthly x 1st 3 months then q6-12months

Front 20

VPA monitoring

Back 20

1)baseline=chem-7, LFTs, CBC, weight
2)followup=serum druglevels, LFTs, CBC, weight monthly x 1st 3 months then q6-12months
3)amylase and lipase levels periodically

Front 21

carbamazepine monitoring

Back 21

1)baseline=CBC w/diff, chem-7, LFTs, CBZ level

Front 22

agent associated with epstein's anomaly during first trimester

Back 22

lithium

Front 23

lithium is widely distributed through tissues including...?

Back 23

kidney, thyroid, bone

Front 24

agent that has no protein binding and is not metabolized

Back 24

lithium

Front 25

onset of action is 7-10d

Back 25

lithium, CBZ (NOT VPA)

Front 26

desired lithium serum concentration

Back 26

0.6-1.2mEq/L

Front 27

this agent has rapid distribution into the CNS and is 90-95% protein bound

Back 27

VPA

Front 28

VPA recommended plasma level

Back 28

50-125mcg/mL

Front 29

this agent has been found to have acute antimanic, antidepressent, and prophylactic effects comparable w/ lithium in bipolar d/o

Back 29

CBZ

Front 30

effect of CBZ clearance with chronic therapy

Back 30

due to autoinduction, CBC clearance can double w/ chronic therapy

Front 31

mood stabilizers that are sedating

Back 31

lithium, VPA, CBZ

Front 32

mood stabilizers that precipitate weight gain

Back 32

lithium, VPA

Front 33

mood stabilizers that cause sexual dysfunction

Back 33

lithium

Front 34

CBZ recommended plasma level

Back 34

6-12mcg/mL

Front 35

When should CBZ be d/c?

Back 35

platelets are <100,000/mm3 or WBC <3000/mm3

Front 36

antipsychotics that have achieved FDA approval for treatment of acute episodes of mania

Back 36

risperidone, quetiapine, ziprasidone, aripiprazole

Front 37

antipsychotics used for bipolar maintenance therapy

Back 37

olanzapine

Front 38

management of an acute episode of mania

Back 38

mood stablizer + BZD +/- atypical AP

Front 39

role of BZDs in acute mania

Back 39

-adjunctive treatment
-useful in minimizing agitation, anxiety, and insomnia

Front 40

what BZD may worsen mania

Back 40

alprazolam

Front 41

1st line antidepressants in bipolar depression

Back 41

bupropion and SSRIs

Front 42

what antidepressants have the greatest potential to precipitate mania?

Back 42

TCAs

Front 43

use of antidepressants for patients who develop acute mania

Back 43

d/c antidepressant

Front 44

what must be done before the addition of an antidepressant in bipolar depression?

Back 44

maximize dose of mood stabilizer

Front 45

what should be evaluated in bipolar depression?

Back 45

thyroid function

Front 46

these agents should be tapered and discontinued once the patient is stabilized

Back 46

BZDs and antidepressants