NURS752: Mood Stabilizers Final
Exam Questions and All Correct
Answers.
What is an elevated mood - Answer 3 symptoms (elation) or 4 symptoms (irritability):
Decreased need for sleep Distractibility Excessive involvement in high-risk pleasurable activity
Flight of ideas Grandiosity Increase in energy, goal-directed activity or psychomotor agitation
Pressured speech
Bipolar spectrum - Answer There is a huge variation in the presentation of patients with
bipolar disorder. Historically, bipolar disorder has been categorized as I, II, or not otherwise
specified (NOS). think of these patients as belonging to a bipolar spectrum and to identify
subcategories of presentations
Bipolar Disorder-Treatment - Answer Acute therapy: manic episode Lithium Valproic acid If
needed: antipsychotic or benzo Acute therapy: depressive phase Mood stabilizer alone or with
an antidepressant Long-term prevention One or more mood stabilizers and other drugs which
are needed acutely
Lithium - Answer MOA: Not clear Lithium is effective both for the manic and depressive
components. Today lithium is preferred for patient with classic (euphoric) mania Onset of effect:
Antimanic effects begin 5-7 days after onset of treatment. Takes 2-3 weeks to see full lithium
effects Renal excretion of lithium is effected by blood levels of sodium When Na levels are
inadequate it retains Lithium in an attempt to compensate. In the presence of hyponatremia,
lithium toxicity can occur
Lithium Gold standard A - Answer 1. The exact mechanism of action for lithium is unknown,
but it appears to be neuroprotective. 2. Lithium continues to be the gold standard for treating
type I bipolar disorder. It is effective for the manic and depressive components. Although it is
not a particularly good antidepressant as monotherapy in unipolar depression, it is effective in
patients with bipolar disorder. Lithium also has anti-suicidal effects when used to treat bipolar
disorder.
Lithium Gold Standard B - Answer 3. Antimanic effects can occur in 1-2 weeks. Most clinicians
use antipsychotics or benzodiazepines as adjunctive therapy during this period to cover the
agitation and other symptoms. Antidepressant effects may take 6-8 weeks. 4. Pharmacokinetics:
Its half-life is 20-24 hours. It is excreted 95% unchanged by glomerular filtration, and anything
that alters the glomerular filtration rate affects its clearance. Pharmacokinetic methods are
, concentrations, symptom relief, and the occurrence of adverse effects. 6. A pre-lithium workup
includes a complete blood cell count, electrolytes, renal function, thyroid function tests,
urinalysis, ECG, and pregnancy test for women of childbearing age.
Lithium gold standard D - Answer 7. Pregnancy: Lithium is teratogenic, particularly in the first
trimester. Women of childbearing age should be counseled on its potential effects. Risks of
discontinuing lithium therapy must be weighed against effects on the fetus when making
decisions regarding lithium therapy during pregnancy.
Lithium MOA - Answer oldest treatment for bipolar disorder, MOA is still not well understood.
Several possible mechanisms exist. affecting signal transduction, inhibition of second-messenger
enzymes such as inositol monophosphatase. modulation of G proteins or by interaction at
various sites within downstream signal transduction cascades.
Lithium Adverse Effects - Answer Adverse Effects:Therapeutic levels:GI effects- nausea,
diarrhea, abdominal bloating).Tremor.Polyuria.Renal toxicity.Goiter and
hypothyroidism.Teratogenesis
Lithium Monitoring - Answer Monitoring: Lithium levels (0.8-1.4 meq/L) Encourage fluid intake
of 2000-3000 ml/day to prevent drug toxicityRenal functionThyroid function testsUrinalysis Q 6
to 12 months
Lithium Monitoring - Answer The half-life 1 day state occurs in about 5 days. Even if it is not
steady state obtain a serum concentration 3 days after dosage changes to rule out toxicity. aim
for concentrations of 0.8-1.2 mEq/L in acute mania. 0.6-1.0 mEq/L during maintenance.
Lithium Concentration - Answer response data are based on 12-hour postdose concentrations,
so concentrations should be ordered in the morning 12 hours after the last evening dose.
Perform renal function tests, thyroid function tests, and a urinalysis every 6-12 months.
Lithium AE - Answer particularly during therapy initiation or after dose changes. what can
occur at therapeutic levels. Gi effects are pretty common. Tremor similar to a Parkinson.
polyuria. Goiter. One of the few drugs that can cause hyper or hypothyroidism and Tourette
agenesis. because lithium is a narrow therapeutic index drug, requires or mandates that it be
monitored very carefully.
Lithium concentrations - Answer General, for test purposes, 0.6 to 1.2. Toxicity can occur very
quickly. Going above the 1.2 level. Symptoms of lithium toxicity include lethargy, coarse tremor,
Exam Questions and All Correct
Answers.
What is an elevated mood - Answer 3 symptoms (elation) or 4 symptoms (irritability):
Decreased need for sleep Distractibility Excessive involvement in high-risk pleasurable activity
Flight of ideas Grandiosity Increase in energy, goal-directed activity or psychomotor agitation
Pressured speech
Bipolar spectrum - Answer There is a huge variation in the presentation of patients with
bipolar disorder. Historically, bipolar disorder has been categorized as I, II, or not otherwise
specified (NOS). think of these patients as belonging to a bipolar spectrum and to identify
subcategories of presentations
Bipolar Disorder-Treatment - Answer Acute therapy: manic episode Lithium Valproic acid If
needed: antipsychotic or benzo Acute therapy: depressive phase Mood stabilizer alone or with
an antidepressant Long-term prevention One or more mood stabilizers and other drugs which
are needed acutely
Lithium - Answer MOA: Not clear Lithium is effective both for the manic and depressive
components. Today lithium is preferred for patient with classic (euphoric) mania Onset of effect:
Antimanic effects begin 5-7 days after onset of treatment. Takes 2-3 weeks to see full lithium
effects Renal excretion of lithium is effected by blood levels of sodium When Na levels are
inadequate it retains Lithium in an attempt to compensate. In the presence of hyponatremia,
lithium toxicity can occur
Lithium Gold standard A - Answer 1. The exact mechanism of action for lithium is unknown,
but it appears to be neuroprotective. 2. Lithium continues to be the gold standard for treating
type I bipolar disorder. It is effective for the manic and depressive components. Although it is
not a particularly good antidepressant as monotherapy in unipolar depression, it is effective in
patients with bipolar disorder. Lithium also has anti-suicidal effects when used to treat bipolar
disorder.
Lithium Gold Standard B - Answer 3. Antimanic effects can occur in 1-2 weeks. Most clinicians
use antipsychotics or benzodiazepines as adjunctive therapy during this period to cover the
agitation and other symptoms. Antidepressant effects may take 6-8 weeks. 4. Pharmacokinetics:
Its half-life is 20-24 hours. It is excreted 95% unchanged by glomerular filtration, and anything
that alters the glomerular filtration rate affects its clearance. Pharmacokinetic methods are
, concentrations, symptom relief, and the occurrence of adverse effects. 6. A pre-lithium workup
includes a complete blood cell count, electrolytes, renal function, thyroid function tests,
urinalysis, ECG, and pregnancy test for women of childbearing age.
Lithium gold standard D - Answer 7. Pregnancy: Lithium is teratogenic, particularly in the first
trimester. Women of childbearing age should be counseled on its potential effects. Risks of
discontinuing lithium therapy must be weighed against effects on the fetus when making
decisions regarding lithium therapy during pregnancy.
Lithium MOA - Answer oldest treatment for bipolar disorder, MOA is still not well understood.
Several possible mechanisms exist. affecting signal transduction, inhibition of second-messenger
enzymes such as inositol monophosphatase. modulation of G proteins or by interaction at
various sites within downstream signal transduction cascades.
Lithium Adverse Effects - Answer Adverse Effects:Therapeutic levels:GI effects- nausea,
diarrhea, abdominal bloating).Tremor.Polyuria.Renal toxicity.Goiter and
hypothyroidism.Teratogenesis
Lithium Monitoring - Answer Monitoring: Lithium levels (0.8-1.4 meq/L) Encourage fluid intake
of 2000-3000 ml/day to prevent drug toxicityRenal functionThyroid function testsUrinalysis Q 6
to 12 months
Lithium Monitoring - Answer The half-life 1 day state occurs in about 5 days. Even if it is not
steady state obtain a serum concentration 3 days after dosage changes to rule out toxicity. aim
for concentrations of 0.8-1.2 mEq/L in acute mania. 0.6-1.0 mEq/L during maintenance.
Lithium Concentration - Answer response data are based on 12-hour postdose concentrations,
so concentrations should be ordered in the morning 12 hours after the last evening dose.
Perform renal function tests, thyroid function tests, and a urinalysis every 6-12 months.
Lithium AE - Answer particularly during therapy initiation or after dose changes. what can
occur at therapeutic levels. Gi effects are pretty common. Tremor similar to a Parkinson.
polyuria. Goiter. One of the few drugs that can cause hyper or hypothyroidism and Tourette
agenesis. because lithium is a narrow therapeutic index drug, requires or mandates that it be
monitored very carefully.
Lithium concentrations - Answer General, for test purposes, 0.6 to 1.2. Toxicity can occur very
quickly. Going above the 1.2 level. Symptoms of lithium toxicity include lethargy, coarse tremor,
