Deck 14: Drugs Used to Treat Bipolar Disorder

Question 1

Patients with bipolar disorder are _____ times more likely to commit suicide compared to the general population.

A)2
B)5
C)10
D)15

Answer 1

C

Question 2

The diagnosis of bipolar disease is:

A)relatively easy under DSM-5 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.

Answer 2

C

Question 3

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

Answer 3

B

Question 4

The lifetime prevalence of bipolar disorder is approximately ______ percent worldwide.

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

Question 5

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

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

Question 6

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

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 7

Antidepressants may be used to treat depression,but this can risk:

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

Question 8

Bipolar disorder is episodic,with alternating periods of mania or depression about _____ percent of the time.

A)20
B)30
C)40
D)50

Question 9

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 10

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 11

Tom has been working hard on a project for his employer.As the project winds down,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.But 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.Tom could be diagnosed with __________ on the basis of this information.

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

Question 12

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 13

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

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

Question 14

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 15

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 16

A bipolar patient classified as a "rapid cycler" would have at least _____ episodes of illness per year.

A)2
B)4
C)6
D)8

Question 17

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 18

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.

Question 19

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 20

Bipolar disorder I is known as the _____ subtype and is _____ than bipolar disorder II.

A)traditional; less severe
B)traditional; more severe
C)primary; less severe
D)primary; more severe

Question 21

The STEP-BD study revealed that the use of antidepressants,along with mood stabilizers,to treat bipolar disorder,tended to increase the rate of:

A)depressive episodes.
B)manic episodes.
C)recovery.
D)side effects.

Question 22

To avoid further complications,lithium users must watch their dietary intake of:

A)salt
B)sugar
C)fats
D)dairy products

Question 23

Lithium has declined in use to treat bipolar disorder due to the following reasons EXCEPT:

A)noncompliance by patients.
B)minimal efficacy.
C)toxicity and side effects.
D)availability of newer alternatives.

Question 24

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 25

Lithium is the lightest of the alkali metals and shares some characteristics with:

A)potassium.
B)calcium.
C)sodium.
D)chloride.

Question 26

Lithium is effective in treating _____ percent of acute manic and hypomanic episodes.

A)20 to 40
B)40 to 60
C)60 to 80
D)80 to 100

Question 27

The half-life of an oral dose of lithium is about _____ hours.

A)10
B)20
C)30
D)40

Question 28

The classic drug ______ was originally used to treat bipolar disorder.

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

Question 29

Lithium:

A)is very effective in rapid cycling patients.
B)rarely produces side effects.
C)is used less frequently now in comparison to antipsychotic and anticonvulsant agents.
D)is ideal for situations in which there is psychiatric comorbidity.

Question 30

Evidence suggests that the mechanism of antimanic drugs may involve effects on:

A)glutamate.
B)GABA.
C)BDNF.
D)lithium receptors.

Question 31

The psychoactive effect of lithium on normal individuals is:

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

Question 32

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

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

Question 33

Lithium:

A)is metabolized in the liver into two active metabolites.
B)crosses the blood-brain barrier rapidly.
C)completely crosses into the brain.
D)has a very narrow therapeutic range.

Question 34

In the STEP-BD study,about _____ percent of the patients who participated for at least 2 years achieved recovery.

A)20
B)40
C)60
D)80

Question 35

The STEP-BD study revealed that the use of antidepressants,along with mood stabilizers,to treat bipolar disorder,tended to _____ the rate of rapid cycling of _____ episodes.

A)decrease; depressive
B)decrease; manic
C)increase; depressive
D)increase; manic

Question 36

The STEP-BD study revealed that ______ is associated with an increased risk of polycystic ovarian syndrome (PCOS).

A)valproic acid
B)inositol
C)lamotrigine
D)risperidone

Question 37

Before excretion,lithium is:

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

Question 38

Lithium crosses the blood-brain barrier:

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

Question 39

Peak blood levels of lithium are reached within _____ hours of oral administration.

A)2
B)3
C)4
D)5

Question 40

In general,those bipolar patients who __________ are likely to have poor outcomes.

A)experience an acute manic episode
B)are rapid cyclers
C)suffer from bipolar depression
D)experience a mild manic episode

Question 41

All of the following drugs for bipolar disorder can cause skin reactions EXCEPT:

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

Question 42

Carbamazepine (Tegretol)is potentially ______ in pregnancy.

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

Question 43

Carbamazepine's benefit for bipolar disorder is thought to be due to a neural mechanism that:

A)blocks the reuptake of serotonin.
B)increases the release of dopamine.
C)enhances GABA receptor sensitivity.
D)inhibits intracellular enzyme activity.

Question 44

Lithium,valproic acid,and lamotrigine are all known to _____ GSK-3 levels,and _____ b-catenin levels.

A)decrease; decrease
B)decrease; increase
C)increase; decrease
D)increase; increase

Question 45

The side effects of lithium include all the following EXCEPT:

A)slurred speech.
B)nausea.
C)ataxia.
D)increased heart rate.

Question 46

Presently,combination therapy for bipolar disorder is common and often involves ______ and lithium.

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

Question 47

Antiepileptics include all of the following drugs EXCEPT:

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

Question 48

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

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

Question 49

Combination therapy,such as lithium and antileptic or antipsychotic,is generally _____ efficacious and _____ common compared to monotherapy

A)less; less
B)less; more
C)more; less
D)more; more

Question 50

_______ is reduced in patients on lithium therapy.

A)Weight gain
B)Suicidal behavior
C)Tremor
D)Muscle weakness

Question 51

Valproic acid (Depakote)and __________ have been reported to be particularly effective in combination.

A)lithium
B)carbamazepine (Tegretol)
C)medical marijuana
D)lamotrigine (Lamictal)

Question 52

_____-generation antiepileptic medications have been shown to be useful for treating _____.

A)First; depression
B)First; bipolar disorder
C)Second; depression
D)Second; bipolar disorder

Question 53

A __________ is one side effect of lithium.

A)skin reaction
B)dry mouth
C)profuse sweating
D)weight loss

Question 54

The therapeutic range of lithium is _______ and the antidote for overdose is ______.

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

Question 55

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

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

Question 56

Skin reactions to carbamazepine are especially prevalent among:

A)Asians.
B)Africans.
C)Europeans.
D)South Americans.

Question 57

The nonadherence rate for lithium use is about _____ percent of bipolar patients.

A)10
B)25
C)50
D)75

Question 58

The side effects of lithium include all the following EXCEPT:

A)cognitive deficits.
B)motor deficits.
C)dehydration.
D)seizures.

Question 59

Chronic lithium ingestion may cause the ______ to enlarge.

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

Question 60

The two greatest dangers when using second-generation antiepileptic drugs are:

A)anxiety and depression.
B)cardiotoxicity and diabetes.
C)suicides and birth defects.
D)addiction and cognitive deficits.

Question 61

Neuropathic pain is often treated with:

A)zonisamide (Zonegran).
B)gabapentin (Neurontin).
C)topiramate (Topamax).
D)tiagabine (Gabitril).

Question 62

Compared to carbamazepine,oxcarbazepine is:

A)safer with similar efficacy.
B)safer with better efficacy.
C)more dangerous with similar efficacy.
D)more dangerous with better efficacy.

Question 63

Prevention of mania and hypomania associated with bipolar disorder involves:

A)pharmacological treatment.
B)ruling out liver disease as a cause of symptoms.
C)psychoeducation.
D)compliance with pharmacological treatment and psychoeducation.

Question 64

Valproic acid affects the _______ system.

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

Question 65

A meta-analysis of antipsychotic drugs used to treat bipolar disorder suggests that ______ is superior to all others.

A)quetiapine
B)valproate
C)haloperidol
D)olanzapine

Question 66

For the prevention of relapse marked by ______,the third-generation anticonvulsant neuromodulator lamotrigine (Lamictal)is reportedly better than lithium.

A)manic episodes
B)depressive episodes
C)acute bipolar episodes
D)acute bipolar depression

Question 67

Of all the antiepileptic drugs,_____ has been found to be the safest to use in pregnancy.

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

Question 68

To ______ is gabapentin's mechanism of action.

A)block receptor activity
B)enhance receptor sensitivity
C)decrease neurotransmitter levels
D)increase neurotransmitter levels

Question 69

__________ and __________ are the two greatest dangers when using topiramate (Topamax).

A)anxiety; depression
B)cardiotoxicity; diabetes
C)suicides; addiction
D)birth defects; cognitive deficits

Question 70

______ is the primary side effect observed in up to 8 percent of patients being treated with valproic acid.

A)Heart disease
B)Convulsions
C)Loss of white blood cells
D)Obesity

Question 71

The most dangerous and potentially fatal risk of using lamotrigine (Lamictal)is:

A)skin reactions.
B)heart attack.
C)immunosuppression.
D)suicidality.

Question 72

Gabapentin is particularly useful for the treatment of:

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

Question 73

______ is the neurotransmitter most clearly linked to bipolar disorder.

A)Serotonin
B)Dopamine
C)GABA
D)Acetylcholine

Question 74

Topiramate (Topamax)is reported to induce significant:

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

Question 75

Various formulations of ______ are found in Depakene,Depacon,and Depakote.

A)carbamazepine
B)oxcarbazepine
C)valproate
D)lamotrigine