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for the Psychiatry Clerkship

Jeopardy. for the Psychiatry Clerkship. And Now Here Is The Host. is proud to present. Insert Name Here. The categories for today’s Jeopardy on Mood Stabilizers will be:. Lithium. Divalproex Sodium. Carbamazepine. Lamotrigine. Antipsychotics. Lithium. Anitpsychotics.

ralph-adams
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for the Psychiatry Clerkship

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  1. Jeopardy for the Psychiatry Clerkship

  2. And Now Here Is The Host . . . is proud to present Insert Name Here

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

  4. Lithium

  5. Divalproex Sodium

  6. Carbamazepine

  7. Lamotrigine

  8. Antipsychotics

  9. Lithium Anitpsychotics Divalproex Sodium Carbamazepine Lamotrigine 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? (Trough) Blood levels should be drawn about this many hours after the last dose

  11. 1,2 What is 0.6-0.8 mEq/L? For maintenance treatment of Bipolar disorder, lithium levels should generally be above this

  12. 1,3 What is TSH & BUN/creatinine? Before starting a young male patient on lithium, labs that should routinely be done are these

  13. 1,4 What islithium level, TSH, BUN/creatinine? In lithium maintenance treatment, ideally these labs are done 1-2 times per year

  14. 1,5 What is tremor? (resting or postural?) This lithium side effect can be worsened by caffeine or improved with propranolol treatment

  15. 1,6 What is suicide? Unlike any antidepressant or mood stabilizer, Lithium treatment decreases patient’s mortality risk from this

  16. 1,7 What is dialysis? Lithium toxicity with a lithium level greater than 4.0 mEq/L is treated with this

  17. 1,8 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

  18. 1,9 What is lithium toxicity? For patients taking lithium, renal impairment, sodium depletion, or dehydration all increase the risk of this

  19. 2,1 What is neural tube defect (spina bifida)? Divalproex Sodium (Depakote) exposure during the first trimester of pregnancy increases the risk this serious congenital anomaly

  20. 2,2 What are LFT’s & platelets? Before starting a male patient on Divalproex Sodium (Depakote), these two lab tests should be done

  21. 2,3 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.

  22. 2,4 What is tremor? (resting or postural?) Propranolol 2-3x’s per day may be used to treat this common side effect of divalproex (depakote)

  23. 2,5 What is under 2 years old ? The age range of patients most at risk for divalproex’s (depakote) side effect of serious, possibly fatal, hepatoxicity is this

  24. 2,6 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)

  25. 2,7 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

  26. 2,8 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

  27. 2,9 What is decreased platelets? Thrombocytopenia For a patient taking Divalproex Sodium (Depakote), taking aspirin increases the risk of this

  28. 3,1 What is auto-induction? Over the first few weeks of taking carbamazepine (tegretol) its t1/2 will decease to less than 50%of its initial t1/2 due to this

  29. 3,2 What is neural tube defect? Exposure of the fetus during the 1st trimester of pregnancy leads to an unacceptable risk of this

  30. 3,3 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

  31. 3,4 What is sodium? This electrolyte that may be abnormally low in patient’s who are taking carbamazepine (tegretol)

  32. 3,5 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

  33. 3,6 What is becoming pregnant? Sexually active women taking carbamazepine (tegretol) & hormonal birth control are at risk of this

  34. 3,7 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

  35. 3,8 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

  36. 3,9 What is folate? To  the risk of birth defects, a woman on carbemazepine (tegretol) who desires to become pregnant should also take this medication

  37. 4,1 What is 10%? Patients who start taking lamotrigine (lamictal) have a this % risk of developing a benign rash

  38. 4,2 What is Steven’s 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%

  39. 4,3 What is Steven’s Johnson Syndrome? The 4 picture set shows this side effect of lamictal(lamotrigine)

  40. 4,4 What is increasing? (doubles) The drug-drug interaction between lamotrigine (lamictal) & divalproex sodium (depakote) results in lamictal’s blood level doing this

  41. 4,5 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

  42. 4,6 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

  43. 4,7 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

  44. 4,8 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)

  45. 4,9 What is Sodium channels? Similar to mood stabilizers such as carbamazepine (tegretol), and divalproex (depakote), lamotrigine’s (lamictal) mechanism of action includes blocking these

  46. 5,1 What is olanzapine (zyprexa)? This SGA is used to treat acute mania or for maintenance treatment of bipolar disorder, but of all the SGA’s it has the highest risk for weight gain, elevated lipids, and diabetes

  47. 5,2 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 > 50% will not be absorbed in the digestive tract

  48. 5,3 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

  49. 5,4 What is risperidone (risperdal)? This SGA is used to treat acute mania or for maintenance treatment of bipolar disorder, but at doses > 6 mg it acts more like a FGA and has a much higher rate of EPS side effects

  50. 5,5 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

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