for the Psychiatry Clerkship

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Jeopardy

• for the Psychiatry Clerkship

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And Now Here Is The Host . . .
is proud to present
Insert Name Here
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• The categories for todays Jeopardy on Mood
  Stabilizers will be

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Lithium
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Divalproex Sodium
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Carbamazepine
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Lamotrigine
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Antipsychotics
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Anitpsychotics
Divalproex Sodium
Carbamazepine
Lamotrigine
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What is 12 hours? (Trough)
Blood levels should be drawn about this many
hours after the last dose

• Row 1, Col 1

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What is 0.6-0.8 mEq/L?
For maintenance treatment of Bipolar disorder,
lithium levels should generally be above this

• 1,2

12
What is TSH BUN/creatinine?
Before starting a young male patient on lithium,
labs that should routinely be done are these

• 1,3

13
What is lithium level, TSH, BUN/creatinine?
In lithium maintenance treatment, ideally these
labs are done 1-2 times per year

• 1,4

14
What is tremor? (resting or postural?)
This lithium side effect can be worsened by
caffeine or improved with propranolol treatment

• 1,5

15
What is suicide?
Unlike any antidepressant or mood stabilizer,
Lithium treatment decreases patients mortality
risk from this

• 1,6

16
What is dialysis?
Lithium toxicity with a lithium level greater
than 4.0 mEq/L is treated with this

• 1,7

17
What is 5 days? (Lithium half life ?)
After starting lithium or increasing the dose, a
lithium level should be done after this number
of days

• 1,8

18
What is lithium toxicity?
For patients taking lithium, renal impairment,
sodium depletion, or dehydration all increase
the risk of this

• 1,9

19
What is neural tube defect (spina bifida)?
Divalproex Sodium (Depakote) exposure during the
first trimester of pregnancy increases the risk
this serious congenital anomaly

• 2,1

20
What are LFTs platelets?
Before starting a male patient on Divalproex
Sodium (Depakote), these two lab tests should
be done

• 2,2

21
What is decrease Lamotrigine dose by half?
If a patient is taking Lamotrigine (Lamictal)
this needs to be done if Divalproex Sodium
(Depakote) is to be added to the medication
regimen.

• 2,3

22
What is tremor? (resting or postural?)
Propranolol 2-3xs per day may be used to treat
this common side effect of divalproex (depakote)

• 2,4

23
What is under 2 years old ?
The age range of patients most at risk for
divalproexs (depakote) side effect of serious,
possibly fatal, hepatoxicity is this

• 2,5

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What are GI side effects? (N/V/D, GI discomfort)
Because divalproex (depakote) is enteric coated
this side effect is less likely, or at least less
severe, than in the generic form of valproic acid
(depakene)

• 2,6

25
What is Headache? (indicated for migraine
prophylaxis)
Ironically, divalproex (depakote) is indicated
as prophylaxis for this condition, which is also
one of divalproex (depakote)s common side
effects

• 2,7

26
What is 18 hour after the last dose? IR-last dose
10pm, blood draw 10am ER-last dose 10pm, blood
draw 4 pm
For divalproex (depakote), while the trough
level of the Immediate Release (IR) should be
drawn 12 hrs after the last dose, the trough
level of Extended Release (ER) should be drawn
at this time

• 2,8

27
What is decreased platelets? Thrombocytopenia
For a patient taking Divalproex Sodium
(Depakote), taking aspirin increases the risk of
this

• 2,9

28
What is auto-induction?
Over the first few weeks of taking carbamazepine
(tegretol) its t1/2 will decease to less than
50of its initial t1/2 due to this

• 3,1

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What is neural tube defect?
Exposure of the fetus during the 1st trimester of
pregnancy leads to an unacceptable risk of this

• 3,2

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What is agranulocytosis aplastic anemia?

• Carbamazepine (tegretol) has a
• black box warning for these two
• rare (1/100,000 0.001)
• but serious side effects on
• the hematopoietic system

• 3,3

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What is sodium?
This electrolyte that may be abnormally low in
patients who are taking carbamazepine
(tegretol)

• 3,4

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What is CYP 3A4?
CYP 3A4 2D6 2C9 This cytochrome p450
enzyme system makes up 55 of the cytochrome
p450 enzymes Carbamazepine (Tegretol) is both
a substrate an inducer of this system

• 3,5

33
What is becoming pregnant?
Sexually active women taking carbamazepine
(tegretol) hormonal birth control are at risk
of this

• 3,6

34
What is oxcarbamazepine (trileptal)?
Closely related structurally to carbamazepine
(tegretol), this medication has far fewer side
effects but is not FDA approved for treatment
of bipolar disorder

• 3,7

35
What is liver function test?
Patients who are getting long term treatment with
divalproex (depakote) or carbamazepine (tegretol)
need to have regular labs done to check their
medication blood levels, platelets/blood count,
and this

• 3,8

36
What is folate?
To ? the risk of birth defects, a woman on
carbemazepine (tegretol) who desires to become
pregnant should also take this medication

• 3,9

37
What is 10?
Patients who start taking lamotrigine (lamictal)
have a this risk of developing a benign rash

• 4,1

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What is Stevens Johnson Syndrome?
While the side effect of a benign rash is
relatively common, the risk of a severe rash is
about 0.3, and the risk of this is about
0.02-0.1

• 4,2

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What is Stevens Johnson Syndrome?
The 4 picture set shows this side effect
of lamictal(lamotrigine)

• 4,3

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What is increasing? (doubles)
The drug-drug interaction between lamotrigine
(lamictal) divalproex sodium (depakote) results
in lamictals blood level doing this

• 4,4

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What is treats bipolar depression
Lamotrigine (lamictal), quetiapine (seroquel),
lithium, olanzapine/fluoxetine (symbyax),
latuda (lurasidone) all have this in common
regarding their usage in the treatment of pts
with bipolar disorder

• 4,5

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What is use in maintenance treatment of bipolar
disorder?
Lamotrigine (lamictal), lithium, quetiapine
(seroquel), olanzapine (zyprexa) aripiprazole
(abilify) all have this in common regarding
their usage in treatment of pts with bipolar
disorder

• 4,6

43
What is an acute manic episode?
Lithium, divalproex (depakote), carbamazepine ER
(tegretol ER) quetiapine (seroquel), ziprasidone
(geodon), asenapine (saphris) can treat this
phase of bipolar disorder but lamotrigine
(lamictal) cannot

• 4,7

44
What is weight gain and sedation?
Two common side effects of lithium, divalproex
(depakote), quetiapine (seroquel), olanzapine
(zyprexa) are this this which are NOT side
effects of lamotrigine (lamictal)

• 4,8

45
What is Sodium channels?
Similar to mood stabilizers such as carbamazepine
(tegretol), and divalproex (depakote),
lamotrigines (lamictal) mechanism of action
includes blocking these

• 4,9

46
What is olanzapine (zyprexa)?
This SGA is used to treat acute mania or for
maintenance treatment of bipolar disorder, but of
all the SGAs it has the highest risk for weight
gain, elevated lipids, and diabetes

• 5,1

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What is ziprasidone (geodon)?
This SGA is used to treat acute mania or for
maintenance treatment of bipolar disorder, but
must be taken with food or gt 50 will not be
absorbed in the digestive tract

• 5,2

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What is aripiprazole (abilify)?
While this SGA is used to treat acute mania or
for maintenance treatment of bipolar disorder, it
has a particularly long half life of 75 hours
and takes nearly 2 weeks to reach steady state

• 5,3

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What is risperidone (risperdal)?
This SGA is used to treat acute mania or for
maintenance treatment of bipolar disorder, but at
doses gt 6 mg it acts more like a FGA and has a
much higher rate of EPS side effects

• 5,4

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What is asenapine (saphris)?
This SGA is used to treat acute mania must be
taken sublingually because if it is swallowed
only 5 will be bioavailable due to 1st pass
liver metabolism

• 5,5

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What is ziprasidone (geodon)
aripiprazole (abilify)?
These 2 SGAs, in addition to being used to treat
acute mania or for maintenance treatment of
bipolar disorder, are the least likely of the
SGAs to cause weight gain or metabolic syndrome

• 5,6

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What is ziprasidone (geodon)?
This SGA is used to treat acute mania or for
maintenance treatment of bipolar disorder, but
should not be used in patients with ECGs that
show an QTc gt 500 milliseconds

• 5,7

53
What are quetiapine (seroquel), latuda
(lurasidone) olanzapine (zyprexa)?
These three SGAs are useful is treating bipolar
depression two by themselves, the other in
combination with fluoxetine (prozac)

• 5,8

54
What is aripiprazole (abilify maintena)
olanzapine (zyprexa relprevv)
Risperidone (risperdal consta), paliperidone
(invenga sustenna), and these 2 SGAs are
available in a long acting injectable form

• 5,9