For MHD & Therapeutics

is proud to present And Now Here Is The Host... Dr. Schilling

The categories for today’s Jeopardy will be:

Li +

DDI

Mood Stabilizers

Bipolar treatment

Bipolar Diagnosis

Li + Mood Stabilizers Bipolar Diagnosis Bipolar Tx DDI’s

Row 1, Col 1 Drawing an accurate Li + level requires it be drawn 5-7 days after a dosage change & this number of hours after the last dose was taken What is 12 hours?

1,2  Thyroid function  concentration  Parathyroid function  WBC’s ============================= This side effect is a uncommon to rare side effect from Li + treatment What is  Parathyroid function?

1,3 Advanced Age Pregnancy Na + depletion Dehydration ============================= This results in  Li + levels What is Pregnancy?

1,4 This side effect is common and its symptoms overlap with depression as well as some other Li + side effects What is  Thyroid function?

1,5 Ataxia Dysarthria Seizures Nystagmus ========================= A symptom of severe Li + toxicity is this What are Seizures?

1,6 Weight gain from taking Li + may be due to some short term water accumulation, may be a long term Li + side effect, and may be due to this What is  Thyroid function?

1,7 Since Li + is freely filtered at the glomerulus and is not bound to any blood proteins, the treatment for severe Li + toxicity is this What is dialysis?

1,8 While Li + toxicity & long term (10+ years) Li + treatment are risk factors for this Li + side effect, it may be treated with a specific K + sparing diuretic What is Nephrogenic Diabetes Insipidus (NDI)?

1,9 In addition to treating acute mania, bipolar depression, and being used for maintenance treatment, Li + has this unique treatment ability What is  suicide risk?

2,1 Because thiazide diuretics inhibit NaCl reabsorption in the distal convoluted tubules, patients taking Li + will have their Li + levels do this What is increase?

2,2 Diuretics that have their effect before the loop of Henle tend to do this to Li + levels What is decrease?

2,3 Phenytoin toxicity is a risk when adding depakote because depakote inhibits phenytoin’s metabolism and depakote does this to phenytoin What is displaces from blood proteins?

2,4 Other medications induce or inhibit carbamazepine’s (tegretol) metabolism via the CYP450 system while carbamazepine’s CYP 450 interactions cause this in other medications What is induction of other medication’s metabolism?

2,5 What is increase (double)? Depakote’s interaction with the glucuronidation system results in lamictal levels doing this

2,6 ACE Inhibitors and Angiotensin II antagonists  aldosterone which results in patients taking Li + having their Li + levels do this What is increase?

2,7 A sexually active woman taking oral birth control pills who starts carbamazepine (tegretol) is at risk for this What is pregnancy (failure of the birth control)?

2,8 Aspirin & caffeine’s DDI with depakote may cause depakote toxicity via this mechanism What is  the free fraction by displacing Depakote from blood proteins?

2,9 These 2 mood stabilizers can induce their own metabolism What is Carbamazepine (Tegretol) & Lamotrigine (Lamictal)?

3,1 At greatest risk of serious hepatotoxicity from depakote are patients who are treated with multiple medications & are in this age range What is <2 years old?

3,2 While Li + treatment may result in this blood component increasing, carbamazepine (tegretol) treatment may result in this blood component decreasing What is while blood cells (WBC’s)?

3,3 The 4 picture set shows this side effect of lamictal (lamotrigine) What is Steven’s Johnson Syndrome (SJS)?

3,4 This electrolyte may be abnormally low in patients who are taking carbamazepine (tegretol) What is sodium (Na + )?

3,5 Both of these mood stabilizers carry the teratogenic risk for a neural tube defect What is Sodium Valproate (Depakote) & Carbamazepine (Tegretol)?

3,6 Li + increases the teratogenic risk of this from 1 in 20,000 (0.005%) to 1 in ( %) What is Ebstein’s anomaly?

3,7 Carbamazepine (Tegretol) & Clozapine (Clozaril) both may cause this serious side effect to the hematopoietic system What is agranulocytosis?

3,8 Nausea Tremor Sedation Weight gain =========================== Sodium Valproate (Depakote) & Carbamazepine (Tegretol) have this side effect(s) in common What is all 4?

3,9 Lamotrigine (Lamictal) is very gradually titrated up to its target dose in order to minimize this common side effect What is rash?

4,1 While this medication may be used for bipolar maintenance treatment, curiously it is not effective for treating acute mania What is lamotrigine (lamictal)?

4,2 SGA’s that are approved for treatment of bipolar depression are quetiapine (seroquel), lurasidone (latuda) and this What is olanzapine & fluoxetine (Symbyax)?

4,3 Severe mania is typically treated with either Lithium or Sodium Valproate (Depakote) and these medications What is Second Generation Antipsychotics (SGAs)?

4,4 First Generation Antipsychotics are FDA approved for treating this phase of bipolar disorder What is acute manic phase?

4,5 While not absolutely contraindicated, a last resort medication treatment for pregnant bipolar patient is this What is Sodium Valproate (Depakote) ?

4,6 The one consensus in treating bipolar disorder is to NOT do this What is antidepressant monotherapy?

4,7 Lithium and the three mood stabilizers are all approved for treating this phase of Bipolar disorder What is maintenance phase?

4,8 This was the first medication approved for treating bipolar disorder What is Lithium?

4,9 This mood stabilizer is NOT considered a first line treatment for bipolar disorder What is carbamazepine (tegretol)?

5,1 Mania Depression ========================= In Bipolar I disorder, patients spend more time in this phase than the other What is depression?

5,2 Mania Depression ============================ In Bipolar II disorder, patients spend more time in this phase than the other What is depression?

5,3 While Bipolar II disorder and cyclothymia have different time requirements, diagnostically the biggest difference between the two is this What is Major Depression Episode?

5,4 Mixed features Rapid cycling ============================ Poor prognostic feature that may be seen in Bipolar I and/or Bipolar II What is both?

5,5 If a patient experiences a hypomanic episode, then a depressive episode, and then a manic episode the diagnosis is this What is Bipolar I disorder?

5,6 LongerShorter ============================ Compared to Major depression, the time requirement for Bipolar I disorder is this What is shorter?

5, all =========================== The number of symptoms that overlap between a Bipolar I manic episode and a Bipolar II hypomanic episode is this What is all of them (7, 8 if you count the mood)?

5,8 While Bipolar I is equally common in males & females, it appears that Bipolar II, like Major Depression, is more common in this sex What is females?

5,9 Bipolar IBipolar II Major Depression ========================== Psychosis is NOT seen in this illness What is Bipolar II?