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For MHD & Therapeutics

Join Dr. Schilling in this Jeopardy game focused on Li+ DDI, Mood Stabilizers, Bipolar treatment, and Bipolar Diagnosis.

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For MHD & Therapeutics

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  1. Jeopardy For MHD & Therapeutics

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

  3. The categories for today’s Jeopardy will be:

  4. Li+

  5. DDI

  6. Mood Stabilizers

  7. Bipolar treatment

  8. Bipolar Diagnosis

  9. Li+ Bipolar Diagnosis 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

  10. Row 1, Col 1 What is 12 hours? 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

  11. 1,2 What is Parathyroid function? Thyroid function  concentration • Parathyroid function  WBC’s ============================= This side effect is a uncommon to rare side effect from Li+ treatment

  12. 1,3 What is Pregnancy? Advanced Age Pregnancy Na+ depletion Dehydration ============================= This results in  Li+ levels

  13. 1,4 What isThyroid function? This side effect is common and its symptoms overlap with depression as well as some other Li+ side effects

  14. 1,5 What are Seizures? Ataxia Dysarthria Seizures Nystagmus ========================= A symptom of severe Li+ toxicity is this

  15. 1,6 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

  16. 1,7 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

  17. 1,8 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

  18. 1,9 What is suicide risk? In addition to treating acute mania, bipolar depression, and being used for maintenance treatment, Li+ has this unique treatment ability

  19. 2,1 What is increase? Because thiazide diuretics inhibit NaCl reabsorption in the distal convoluted tubules, patients taking Li+ will have their Li+ levels do this

  20. 2,2 What is decrease? Diuretics that have their effect before the loop of Henle tend to do this to Li+ levels

  21. 2,3 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

  22. 2,4 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

  23. 2,5 What is increase (double)? Depakote’s interaction with the glucuronidation system results in lamictal levels doing this

  24. 2,6 What is increase? ACE Inhibitors and Angiotensin II antagonists aldosterone which results in patients taking Li+ having their Li+ levels do this

  25. 2,7 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

  26. 2,8 What is  the free fraction by displacing Depakote from blood proteins? Aspirin & caffeine’s DDI with depakote may cause depakote toxicity via this mechanism

  27. 2,9 What is Carbamazepine (Tegretol) & Lamotrigine (Lamictal)? These 2 mood stabilizers can induce their own metabolism

  28. 3,1 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

  29. 3,2 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

  30. 3,3 What is Steven’s Johnson Syndrome (SJS)? The 4 picture set shows this side effect of lamictal (lamotrigine)

  31. 3,4 What is sodium (Na+)? This electrolyte may be abnormally low in patients who are taking carbamazepine (tegretol)

  32. 3,5 What is Sodium Valproate (Depakote) & Carbamazepine (Tegretol)? Both of these mood stabilizers carry the teratogenic risk for a neural tube defect

  33. 3,6 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%)

  34. 3,7 What is agranulocytosis? Carbamazepine (Tegretol) & Clozapine (Clozaril) both may cause this serious side effect to the hematopoietic system

  35. 3,8 What is all 4? Nausea Tremor Sedation Weight gain =========================== Sodium Valproate (Depakote) & Carbamazepine (Tegretol) have this side effect(s) in common

  36. 3,9 What is rash? Lamotrigine (Lamictal) is very gradually titrated up to its target dose in order to minimize this common side effect

  37. 4,1 What is lamotrigine (lamictal)? While this medication may be used for bipolar maintenance treatment, curiously it is not effective for treating acute mania

  38. 4,2 What is olanzapine & fluoxetine (Symbyax)? SGA’s that are approved for treatment of bipolar depression are quetiapine (seroquel), lurasidone (latuda) and this

  39. 4,3 What is Second Generation Antipsychotics (SGAs)? Severe mania is typically treated with either Lithium or Sodium Valproate (Depakote) and these medications

  40. 4,4 What is acute manic phase? First Generation Antipsychotics are FDA approved for treating this phase of bipolar disorder

  41. 4,5 What is Sodium Valproate (Depakote) ? While not absolutely contraindicated, a last resort medication treatment for pregnant bipolar patient is this

  42. 4,6 What is antidepressant monotherapy? The one consensus in treating bipolar disorder is to NOT do this

  43. 4,7 What is maintenance phase? Lithium and the three mood stabilizers are all approved for treating this phase of Bipolar disorder

  44. 4,8 What is Lithium? This was the first medication approved for treating bipolar disorder

  45. 4,9 What is carbamazepine (tegretol)? This mood stabilizer is NOT considered a first line treatment for bipolar disorder

  46. 5,1 What is depression? Mania Depression ========================= In Bipolar I disorder, patients spend more time in this phase than the other

  47. 5,2 What is depression? Mania Depression ============================ In Bipolar II disorder, patients spend more time in this phase than the other

  48. 5,3 What is Major Depression Episode? While Bipolar II disorder and cyclothymia have different time requirements, diagnostically the biggest difference between the two is this

  49. 5,4 What is both? Mixed features Rapid cycling ============================ Poor prognostic feature that may be seen in Bipolar I and/or Bipolar II

  50. 5,5 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

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