Deck 14: Drugs Used to Treat Bipolar Disorder

Question 1

Antidepressants may be used to treat depression in this population but there is risk of:

A) infection.
B) cardiac effects.
C) a manic flip.
D) worsening depression.

Answer 1

C

Question 2

Lithium crosses the blood-brain barrier:

A) rapidly and completely.
B) slowly and incompletely.
C) rapidly but incompletely.
D) slowly but completely.

Answer 2

B

Question 3

Before excretion,lithium is:

A) metabolized to an active compound.
B) metabolized into an inactive compound.
C) converted to Na+.
D) not metabolized.

Answer 3

D

Question 4

Nowadays,combination therapy for bipolar disorder is common often involving lithium and:

A) benzodiazepines.
B) antidepressants.
C) Na+.
D) antiepileptics.

Question 5

The percentage of bipolar disorder I patients with a history of substance abuse is approximately _____ percent.

A) 20
B) 60
C) 80
D) less than 10

Question 6

Long-term management of bipolar disorder is best accomplished with:

A) minor tranquilizers.
B) major tranquilizers.
C) mood stabilizers.
D) antipsychotics.

Question 7

Long-term treatment with antidepressant/mood stabilizer combinations may _____ severity of _____ symptoms.

A) improve; depressive
B) worsen; depressive
C) improve; manic
D) worsen; manic

Question 8

In long-term therapy,up to 30 percent of patients taking lithium experience:

A) kidney failure.
B) heart failure.
C) ulcers.
D) obesity.

Question 9

The classic drug for treating bipolar disorder is:

A) Haldol.
B) benzodiazepines.
C) lithium.
D) Tegretol.

Question 10

The therapeutic range of lithium is _______; the antidote upon overdose is ______.

A) wide; readily available
B) extremely narrow; readily available
C) wide; unavailable
D) extremely narrow; unavailable

Question 11

Following administration,lithium levels can be detected up to:

A) 12 hours.
B) 24 hours.
C) 1 to 2 days.
D) 1 to 2 weeks.

Question 12

When therapy is initiated,lithium continuously accumulates over the next:

A) 12 hours.
B) 24 hours.
C) 2 days.
D) 2 weeks.

Question 13

More than 80 percent of bipolar substance abusers self-administer:

A) alcohol.
B) nicotine.
C) cocaine.
D) marijuana.

Question 14

Antiepileptics include all of the following drugs,EXCEPT:

A) lithium.
B) carbamazepine (Tegretol).
C) valproic acid (Depakote).
D) lamotrigine (Lamictal).

Question 15

The lifetime prevalence of bipolar disorder is approximately ______ worldwide.

A) 1%
B) 2%
C) 3%
D) 10%

Question 16

Pharmacodynamically,lithium and valproate have been shown to protect cultured brain cells from:

A) oxidative stress.
B) stress associated with heat.
C) disease.
D) chemical toxins.

Question 17

Chronic lithium ingestion may cause the ______ to enlarge.

A) kidneys
B) adrenal glands
C) heart
D) thyroid

Question 18

Carbamazepine (Tegretol)is potentially ______ in pregnancy.

A) useful
B) effective
C) ineffective
D) teratogenic

Question 19

The psychoactive effect of lithium on normal individuals is:

A) euphoria.
B) mania.
C) depression.
D) nonexistent.

Question 20

The administration of a(n)______in addition to an antidepressant is recommended for patients suspected of experiencing bipolar depression.

A) antipsychotic
B) mood stabilizer
C) stimulant
D) hallucinogen

Question 21

Hypomania is defined as a less severe form of bipolar disorder.

Question 22

Valproic acid (Depakote)has been reported to be particularly effective in combination with:

A) lithium.
B) carbamazepine (Tegretol).
C) valproic acid (Depakote).
D) lamotrigine (Lamictal).

Question 23

Patients with mixed episodes of mania and depression within the same episode generally show a later age of onset.

Question 24

The classic mood stabilizer is lithium.

Question 25

Zonisamide (Zonegran)is thought to work via action at:

A) sodium
B) potassium
C) chloride
D) presynaptic transporters.

Question 26

The onset of bipolar disorder typically occurs during the teenage years.

Question 27

The neurotransmitter most clearly linked to bipolar disorder is:

A) serotonin.
B) dopamine.
C) GABA.
D) acetylcholine.

Question 28

Bipolar II disorder is more severe than bipolar I.

Question 29

Topiramate (Topamax)is reported to induce significant:

A) cognitive impairment.
B) heart palpitations.
C) heart arrhythmias.
D) skin reactions.

Question 30

Valproic acid (Depakote)affects the _______ system.

A) glutamatergic
B) dopaminergic
C) GABAergic
D) serotonergic

Question 31

Anticonvulsants are _____ effective than antidepressants in treating _____.

A) more; major depression
B) less; major depression
C) more; borderline personality disorder
D) less; borderline personality disorder

Question 32

Of those with substance abuse,approximately 30 percent or fewer bipolar patients abuse alcohol.

Question 33

Bipolar depression typically develops after 25 years of age with a gradual onset of symptoms.

Question 34

Gabapentin is particularly useful for the treatment of:

A) depression.
B) neuropathic pain.
C) bipolar depression.
D) aggression.

Question 35

Of all the mood stabilizers,lithium is probably one of the best for prophylactic treatment of bipolar disorder.

Question 36

Antidepressants decrease the likelihood of a manic switch ("flip").

Question 37

The third-generation anticonvulsant neuromodulator lamotrigine (Lamictal)is reportedly better than lithium at preventing relapse to:

A) any manic episodes.
B) a depressive episodes.
C) acute bipolar episodes.
D) acute bipolar depression.

Question 38

More than half of bipolar patients are substance abusers.

Question 39

The side effect of valproic acid (Depakote)observed in up to 8 percent of patients on the drug is:

A) heart disease.
B) convulsions.
C) loss of white blood cells.
D) obesity.

Question 40

The prevalence of all bipolar disorders is less than 5% of the Unites States population.

Question 41

The effectiveness of lithium is diminished by antiepileptics.

Question 42

Bipolar disorder is associated with neuronal damage.

Question 43

Other than lithium,the best drugs for treating bipolar disorder are antidepressants.

Question 44

Lithium is a teratogen.

Question 45

Other than lithium,the best drugs for treating bipolar disorder are antiepileptics.

Question 46

Many of the antiepileptic drugs produce birth defects.

Question 47

Lithium has a very narrow therapeutic range.

Question 48

Almost half of patients taking lithium stop against medical advice.

Question 49

Fewer than 30 percent of bipolar patients can be adequately controlled by lithium.

Question 50

The terms neuromodulator and anticonvulsant are interchangeable.

Question 51

Lithium therapy may induce suicidal behaviors in those patients being treated for bipolar disorder.

Question 52

Lithium reduces brain damage after brain injury.

Question 53

Lithium had traditionally been the drug physician's most often prescribe for the treatment of bipolar disorder.

Question 54

Goiters may be associated with long-term lithium therapy.

Question 55

There is no antidote to lithium.

Question 56

Obesity is one of the most common side effects of lithium therapy.

Question 57

Lithium is not metabolized before excretion.

Question 58

Lithium slowly crosses the blood-brain barrier.

Question 59

Lithium produces sedation and/or depression in normal individuals.

Question 60

Lithium may be lethal at levels above 2.0 mEq/l.

Question 61

The atypical antipsychotics appear useful in treating mania.

Question 62

Accurately diagnosing someone with bipolar disorder involves:

A) quantifying the number of depressive episodes the person has experienced.
B) getting a good family history.
C) identifying the substances they have used since the onset of symptoms.
D) determining if anticonvulsants cause them to become more manic.

Question 63

As a class,the anticonvulsants are associated with increased risk of suicide.

Question 64

Acute manic episodes that are less severe may be treated effectively with any of the following medications,EXCEPT:

A) lithium.
B) a second generation antipsychotic.
C) valproate.
D) olanzapine.

Question 65

Patients that exhibit mixed episodes of bipolar disorder (symptoms of mania and depression concurrently):

A) generally show an earlier onset of the disorder in comparison to other types.
B) will be less likely to be hospitalized.
C) typically have a very good prognosis compared to other types.
D) usually experience only one or two episodes before complete remission of symptoms.

Question 66

The American Psychiatric Association recommends all of the following goals for general treatment of bipolar disorder,EXCEPT:

A) full return of psychosocial functioning.
B) remission of symptoms.
C) relapse prevention.
D) elimination of all drug side effects.

Question 67

Evidence suggests that topiramate (Topamax)is a teratogen.

Question 68

Valproate (valproic acid)influences DNA to alter genetic processes.

Question 69

The antiepileptic valproate (valproic acid)carries a black box warning concerning pancreatitis.

Question 70

Tom has been working hard on a project for his employer.The project is winding down now and he has recently started exhibiting a very expansive mood,is quite talkative,and reports that he really does not feel the need to sleep much.However,he soon starts to show signs that his mood is somewhat depressed; he also reports that he does not have much interest in his normal activities and that he has gained quite a bit of weight over a short period of time.On the basis of this information,you might diagnosis Tom with:

A) unipolar depression.
B) bipolar disorder I (BP-I).
C) bipolar disorder II (BP-II).
D) mixed bipolar disorder.

Question 71

The major mechanism of action of lamotrigine (Lamictal)is blockade of voltage-gated Na⁺ channels.

Question 72

Lamictal (lamotrigine)is more effective than lithium in preventing relapse to a depressive episode.

Question 73

Lithium,Tegretol,and Depakote are all antiepileptics.

Question 74

Drugs that increase acetylcholine levels produce symptoms reminiscent of mania.

Question 75

The diagnosis of bipolar disease is:

A) relatively easy under DSM-V criteria.
B) generally diagnosed quickly after the onset of symptoms.
C) difficult because of the high comorbidity with other psychiatric disorders.
D) facilitated by the overlap of symptoms seen in unipolar and bipolar depression.

Question 76

Research evidence suggests that all of the following drugs are indicated for acute mania/mixed states EXCEPT:

A) lithium.
B) valproic acid (Valproate).
C) olanzapine .
D) omega-3 fatty acids.

Question 77

Evidence from countries with a diet high in fish suggest that fish oils may provide protection for the brain.

Question 78

The anticonvulsant mood stabilizers have a pronounced effect on borderline personality disorder.

Question 79

In terms of diagnostic criteria,bipolar disorder I (BP-I)involves:

A) evidence of at least four episodes of illness in the last year.
B) indications of onset within adolescence (the teen years).
C) a suggestion of mild onset of mania that becomes progressively worse over time.
D) at least one episode of mania with or without concomitant depression.

Question 80

Comorbid substance abuse:

A) is rare in patients diagnosed with bipolar I disorder.
B) is never seen in patients with bipolar II.
C) typically occurs in younger patients but never in those over 30 years of age.
D) may cause a switch from a depressive to a manic episode.