Transcript Jeopardy

For MHD &
Therapeutics
And Now Here
Is The Host . . .
is proud
to present
Dr. Schilling
The categories for today’s
Jeopardy will be:
+
Li
DDI
Mood Stabilizers
Bipolar
treatment
Bipolar Diagnosis
Li+
DDI’s
Mood
Stabilizers
Bipolar Tx
100
100
100
100
100
200
200
200
200
200
300
300
300
300
300
400
400
400
400
400
500
500
500
500
500
600
600
600
600
600
700
700
700
700
700
800
800
800
800
800
900
900
900
900
900
Bipolar
Diagnosis
What is 12 hours?
+
Li
Drawing an accurate
level
requires it be drawn 5-7 days
after a dosage change & this
number of hours after
the last dose was taken
Row 1, Col 1
What is Parathyroid function?
Thyroid function  concentration
Parathyroid function
 WBC’s
=============================
This side effect is a uncommon to rare
side effect from Li+ treatment
1,2
What is Pregnancy?
Advanced Age
Pregnancy
Na+ depletion
Dehydration
=============================
This results in  Li+ levels
1,3
What isThyroid function?
This side effect is common and its
symptoms overlap with depression
as well as some other Li+ side effects
1,4
What are Seizures?
Ataxia
Dysarthria
Seizures
Nystagmus
=========================
+
A symptom of severe Li
toxicity is this
1,5
What is Thyroid function?
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
1,6
What is dialysis?
Since Li+ is freely filtered at the
glomerulus and is not bound to
any blood proteins, the treatment
for severe Li+ toxicity is this
1,7
What is Nephrogenic Diabetes Insipidus (NDI)?
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
1,8
What is  suicide risk?
In addition to treating acute
mania, bipolar depression, and
being used for maintenance
treatment, Li+ has this unique
treatment ability
1,9
What is increase?
Because thiazide diuretics inhibit
NaCl reabsorption in the distal
convoluted tubules, patients taking
Li+ will have their Li+
levels do this
2,1
What is decrease?
Diuretics that have their effect
before the loop of Henle tend to do
this to Li+ levels
2,2
What is displaces from blood proteins?
Phenytoin toxicity is a risk when
adding depakote because depakote
inhibits phenytoin’s metabolism
and depakote does this
to phenytoin
2,3
What is induction of other medication’s metabolism?
Other medications induce or
inhibit carbamazepine’s (tegretol)
metabolism via the CYP450
system while carbamazepine’s
CYP 450 interactions cause this in
other medications
2,4
What is increase (double)?
Depakote’s interaction with the
glucuronidation system results in
lamictal levels doing this
2,5
What is increase?
ACE Inhibitors and Angiotensin II
antagonists aldosterone which
results in patients taking Li+
having their Li+ levels
do this
2,6
What is pregnancy (failure of the birth control)?
A sexually active woman taking oral
birth control pills who starts
carbamazepine (tegretol) is
at risk for this
2,7
What is  the free fraction by displacing Depakote
from blood proteins?
Aspirin & caffeine’s DDI with
depakote may cause depakote
toxicity via this mechanism
2,8
What is Carbamazepine (Tegretol) & Lamotrigine
(Lamictal)?
These 2 mood stabilizers can induce
their own metabolism
2,9
What is <2 years old?
At greatest risk of serious
hepatotoxicity from depakote are
patients who are treated with
multiple medications & are
in this age range
3,1
What is while blood cells (WBC’s)?
While Li+ treatment may result in
this blood component increasing,
carbamazepine (tegretol)
treatment may result in this
blood component decreasing
3,2
What is Steven’s Johnson Syndrome (SJS)?
The 4 picture set shows this side effect of
lamictal (lamotrigine)
3,3
What is sodium (Na+)?
This electrolyte may be abnormally
low in patients who are taking
carbamazepine (tegretol)
3,4
What is Sodium Valproate (Depakote) & Carbamazepine
(Tegretol)?
Both of these mood stabilizers carry
the teratogenic risk for a
neural tube defect
3,5
What is Ebstein’s anomaly?
Li+ increases the teratogenic
risk of this from
1 in 20,000 (0.005%) to
1 in 1000-2000 (0.1-0.05%)
3,6
What is agranulocytosis?
Carbamazepine (Tegretol) &
Clozapine (Clozaril) both may cause
this serious side effect to the
hematopoietic system
3,7
What is all 4?
Nausea
Tremor
Sedation
Weight gain
===========================
Sodium Valproate (Depakote) &
Carbamazepine (Tegretol) have this
side effect(s) in common
3,8
What is rash?
Lamotrigine (Lamictal) is very
gradually titrated up to its target
dose in order to minimize this
common side effect
3,9
What is lamotrigine (lamictal)?
While this medication may be used for
bipolar maintenance treatment,
curiously it is not effective for
treating acute mania
4,1
What is olanzapine & fluoxetine (Symbyax)?
SGA’s that are approved for treatment
of bipolar depression are quetiapine
(seroquel), lurasidone (latuda)
and this
4,2
What is Second Generation Antipsychotics (SGAs)?
Severe mania is typically treated with
either Lithium or Sodium Valproate
(Depakote) and these medications
4,3
What is acute manic phase?
First Generation Antipsychotics are
FDA approved for treating this phase
of bipolar disorder
4,4
What is Sodium Valproate (Depakote) ?
While not absolutely contraindicated,
a last resort medication treatment
for pregnant bipolar
patient is this
4,5
What is antidepressant monotherapy?
The one consensus in treating
bipolar disorder is to
NOT do this
4,6
What is maintenance phase?
Lithium and the three mood
stabilizers are all approved
for treating this phase of
Bipolar disorder
4,7
What is Lithium?
This was the first medication approved
for treating bipolar disorder
4,8
What is carbamazepine (tegretol)?
This mood stabilizer is NOT
considered a first line treatment
for bipolar disorder
4,9
What is depression?
Mania
Depression
=========================
In Bipolar I disorder, patients
spend more time in this phase
than the other
5,1
What is depression?
Mania
Depression
============================
In Bipolar II disorder, patients
spend more time in this
phase than the other
5,2
What is Major Depression Episode?
While Bipolar II disorder and
cyclothymia have different
time requirements,
diagnostically the biggest
difference between the
two is this
5,3
What is both?
Mixed features
Rapid cycling
============================
Poor prognostic feature that may be
seen in Bipolar I and/or Bipolar II
5,4
What is Bipolar I disorder?
If a patient experiences a hypomanic
episode, then a depressive episode,
and then a manic episode the
diagnosis is this
5,5
What is shorter?
Longer
Shorter
============================
Compared to Major depression, the
time requirement for Bipolar I
disorder is this
5,6
What is all of them (7, 8 if you count the mood)?
3
4
5
all
===========================
The number of symptoms that
overlap between a Bipolar I manic
episode and a Bipolar II hypomanic
episode is this
5,7
What is females?
While Bipolar I is equally common in
males & females, it appears that
Bipolar II, like Major Depression,
is more common in this sex
5,8
What is Bipolar II?
Bipolar I
Bipolar II
Major Depression
==========================
Psychosis is NOT seen in this illness
5,9