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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Lithium
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 ?)
To confirm therapeutic levels 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 Divalproex Sodium (Depakote) is added to the
medication regimen of a patient who is taking
Lamotrigine (Lamictal) this should be done.

• 2,3

22
What is tremor?
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

24
What are GI side effects? (N/V/D, GI discomfort)
Patients on the generic form of valproic acid
(depakene) are at greater risk of developing this
side effect than those on the enteric coated
divalproex (depakote)

• 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? If IR-last
dose 10pm, blood draw 10am If 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

30
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 may be abnormally low in
patients who are taking carbamazepine (tegretol)

• 3,4

32
What is CYP 3A4?
CYP 3A4 2D6 2C9 Carbamazepine
(Tegretol) is both a substrate an inducer of
this cytochrome p450 enzyme system which makes
up 55 of the cytochrome p450 enzymes

• 3,5

33
What is pregnancy?
Carbamazepine (tegretol)s drug-drug interaction
with hormonal birth control increases the 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

38
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 FDA indication to 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 FDA indication for 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) are FDA
indicated to treat this phase of bipolar disorder
but lamotrigine (lamictal) is not

• 4,7

44
What is weight gain and sedation?
Lithium, divalproex (depakote), quetiapine
(seroquel), olanzapine (zyprexa) with regard to
these two common side effects are NOT side
effects of lamotrigine (lamictal)

• 4,8

45
What is Sodium channels?
The common mechanism of action for the mood
stabilizers carbamazepine (tegretol), divalproex
(depakote), and lamotrigine (lamictal) is
blocking these

• 4,9

46
What is olanzapine (zyprexa)?
This SGA has FDA indication 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

47
What is ziprasidone (geodon)?
This SGA has FDA indication 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 has FDA indication 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

49
What is risperidone (risperdal)?
This SGA has FDA indication to treat acute mania
or for maintenance treatment of bipolar
disorder, but at high doses (gt 6 mg) it acts
more like a FGA and has a much higher rate of
EPS side effects

• 5,4

50
What is asenapine (saphris)?
This SGA has FDA indication 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

51
What is ziprasidone (geodon)
aripiprazole (abilify)?
These 2 SGAs, in addition to being FDA indicated
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

52
What is ziprasidone (geodon)?
This SGA is FDA indicated 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 FDA indicated for
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