Valproate in Bipolar Disorder Treatment
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Questions and Answers

What is the FDA approval status of valproate in the treatment of mania?

  • Approved in 1995 (correct)
  • Not approved for mania
  • Still pending approval
  • Approved in the 1960s

    • How does valproate affect GABA function?

  • Does not impact GABA function
  • Blocks GABA receptors
  • Reduces GABA function
  • Enhances GABA function (correct)

    • Which enzyme is involved in the metabolism of valproate?

  • P450 2C9 (correct)
  • P450 1A2
  • P450 2D6
  • P450 3A4

    • What is the bioavailability of valproate when administered orally?

    <p>100%</p> Signup and view all the answers

    What contributes to toxic side effects related to valproate use?

    <p>Interactions with carbamazepine and warfarin</p> Signup and view all the answers

    What is the peak time for valproate levels after administration?

    <p>1 to 4 hours</p> Signup and view all the answers

    What is the typical range for peak plasma levels of valproate?

    <p>50 to 100 mcg/mL</p> Signup and view all the answers

    What is the primary concern with using valproate during the first trimester of pregnancy?

    <p>Neural tube defects including spina bifida</p> Signup and view all the answers

    What is the Pregnancy Category for valproate?

    <p>Pregnancy Category D</p> Signup and view all the answers

    What is the potential effect of valproate on platelet aggregation?

    <p>Decreased platelet aggregation and increased risk of bleeding</p> Signup and view all the answers

    What is the primary concern with using valproate in children younger than 2 years old?

    <p>Increased risk of liver failure</p> Signup and view all the answers

    What is the typical adult dosage range for valproate?

    <p>750 to 3,000 mg/day</p> Signup and view all the answers

    What is the maximum daily dosage of valproate?

    <p>60 mg/kg/day</p> Signup and view all the answers

    What is a potential adverse effect of valproate that may occur during long-term use?

    <p>Alopecia (hair loss)</p> Signup and view all the answers

    What is a potential drug interaction that can occur with the combination of valproate and tricyclic antidepressants (TCAs)?

    <p>Increased risk of cardiotoxicity</p> Signup and view all the answers

    What is a potential concern with using valproate in patients with diabetes?

    <p>Falsely positive ketone urine tests</p> Signup and view all the answers

    What is the recommended trough concentration range for monitoring plasma levels of the drug?

    <p>50 to 125 mcg/mL</p> Signup and view all the answers

    What type of monitoring is recommended for patients taking this drug?

    <p>CBC and chemistries before initiating treatment and then every 3 months for 1 year, then annually</p> Signup and view all the answers

    What should patients be advised about when taking this drug?

    <p>Possible side effects of bruising and delayed clotting</p> Signup and view all the answers

    What is the mechanism of action of lamotrigine?

    <p>Acts as a 5-HT3 blocker and glutamate modulator, inhibiting sodium channels</p> Signup and view all the answers

    Which drug is the only one of the 'nonclassified mood stabilizers' that has been approved by the FDA for treating bipolar disorder?

    <p>Lamotrigine</p> Signup and view all the answers

    What is the mechanism of action of gabapentin?

    <p>Acts as a GABA transporter inhibitor, increasing GABA availability</p> Signup and view all the answers

    What is the recommended initial daily dosage of valproic acid for adults?

    <p>750 mg</p> Signup and view all the answers

    What is the recommended dosage form for valproic acid?

    <p>Oral tablets, capsules, and IV infusion</p> Signup and view all the answers

    Which of the following drug interactions with valproic acid can result in increased sedation and disorientation?

    <p>CNS depressants</p> Signup and view all the answers

    What is the recommended maximum daily dosage of valproic acid for acute mania?

    <p>60 mg/kg/day</p> Signup and view all the answers

    Which of the following muscle relaxants is known to cause significant CNS and respiratory depression?

    <p>Carisoprodol</p> Signup and view all the answers

    Which of these adverse effects is NOT associated with Tizanidine use?

    <p>Hallucinations</p> Signup and view all the answers

    Why should the use of Methocarbamol be cautious in patients taking anticholinesterase medications?

    <p>Methocarbamol may decrease the effect of pyridostigmine</p> Signup and view all the answers

    Which of the following is a contraindicated drug interaction for Tizanidine?

    <p>Fluvoxamine</p> Signup and view all the answers

    What is the maximum daily dose of Baclofen recommended for adult patients?

    <p>80 mg/day</p> Signup and view all the answers

    Which of the following adverse effects is NOT associated with Cyclobenzaprine?

    <p>Bradycardia</p> Signup and view all the answers

    What is the maximum recommended duration of Carisoprodol treatment?

    <p>3 weeks</p> Signup and view all the answers

    Which of the following muscle relaxants is known to cause hepatotoxicity?

    <p>Chlorzoxazone</p> Signup and view all the answers

    Which of the following muscle relaxants has a potentially life-threatening interaction with MAOIs?

    <p>Cyclobenzaprine</p> Signup and view all the answers

    Which of these muscle relaxants is NOT associated with leukopenia or hematologic abnormalities?

    <p>Methocarbamol</p> Signup and view all the answers

    What is the known effect of carisoprodol on the fetus during pregnancy?

    <p>Carisoprodol can cross the placenta and adversely affect fetal growth, but has no clear teratogenic effects.</p> Signup and view all the answers

    What is the primary safety concern with the use of cyclobenzaprine?

    <p>All of the above</p> Signup and view all the answers

    What is the primary safety concern with the use of metaxalone?

    <p>Metaxalone is contraindicated in patients with known hypersensitivity and those with significantly impaired renal or hepatic function.</p> Signup and view all the answers

    What is the primary safety concern with the use of methocarbamol?

    <p>Both a and b</p> Signup and view all the answers

    What is the primary safety concern with the use of orphenadrine?

    <p>Orphenadrine has significant anticholinergic effects and should not be used in patients with urinary retention, prostatic hypertrophy, glaucoma, or achalasia.</p> Signup and view all the answers

    What is the primary safety concern with the use of tizanidine?

    <p>All of the above</p> Signup and view all the answers

    Which muscle relaxant is known to cause hepatotoxicity?

    <p>Chlorzoxazone</p> Signup and view all the answers

    Which muscle relaxant is contraindicated in the acute recovery phase of a myocardial infarction?

    <p>Cyclobenzaprine</p> Signup and view all the answers

    Which muscle relaxant is known to cause serotonin syndrome?

    <p>Cyclobenzaprine</p> Signup and view all the answers

    Which muscle relaxant is not approved for use in children younger than 16 years old?

    <p>Carisoprodol</p> Signup and view all the answers

    What is the main difference between centrally acting muscle relaxants and direct-acting antispasmodics?

    <p>Centrally acting muscle relaxants act on spinal reflexes, while direct-acting antispasmodics act directly on the muscles.</p> Signup and view all the answers

    Which of the following is NOT a centrally acting muscle relaxant?

    <p>Orphenadrine</p> Signup and view all the answers

    How do centrally acting muscle relaxants affect skeletal muscle spasms?

    <p>By inhibiting synaptic reflex arcs</p> Signup and view all the answers

    Which centrally acting muscle relaxant is metabolized via CYP1A2?

    <p>Tizanidine</p> Signup and view all the answers

    What precaution should be taken when prescribing baclofen to patients with a seizure disorder?

    <p>Monitor EEG regularly</p> Signup and view all the answers

    Why should carisoprodol be avoided in patients with porphyria?

    <p>As it can trigger an acute porphyric attack</p> Signup and view all the answers

    Which condition should caution be exercised when prescribing baclofen?

    <p>Renal impairment</p> Signup and view all the answers

    How do centrally acting muscle relaxants relieve muscle spasms?

    <p>By affecting spinal reflexes</p> Signup and view all the answers

    What is a common side effect of centrally acting muscle relaxants?

    <p>CNS sedation</p> Signup and view all the answers

    How are most of the centrally acting muscle relaxants eliminated from the body?

    <p>Metabolized in the liver and excreted in urine</p> Signup and view all the answers

    Which drug has the longest half-life among lamotrigine, topiramate, and gabapentin?

    <p>Lamotrigine</p> Signup and view all the answers

    What is the primary method of excretion for lamotrigine, topiramate, and gabapentin?

    <p>Urine</p> Signup and view all the answers

    Which drug is associated with weight gain among the three discussed medications?

    <p>Gabapentin</p> Signup and view all the answers

    Which side effect is commonly associated with all three drugs?

    <p>Nausea</p> Signup and view all the answers

    What pregnancy category are lamotrigine, topiramate, and gabapentin classified under?

    <p>Category C</p> Signup and view all the answers

    Which drug decreases the effectiveness of oral contraceptives?

    <p>Topiramate</p> Signup and view all the answers

    Which adverse reaction has a rare occurrence with lamotrigine and topiramate within the first 2 to 8 weeks of therapy?

    <p>SJS</p> Signup and view all the answers

    What is advised for patients taking topiramate due to the risk of kidney stones?

    <p>Drinking plenty of water</p> Signup and view all the answers

    What is the recommended initial dose of cyclobenzaprine for the short-term treatment of painful muscle spasms?

    <p>5 mg three times a day for 2 to 3 weeks</p> Signup and view all the answers

    What action should be taken with the dose of cyclobenzaprine once improvement occurs?

    <p>The dose should be reduced.</p> Signup and view all the answers

    Which muscle relaxant is less sedating and suitable for daytime use to minimize the risk of impaired driving?

    <p>Methocarbamol</p> Signup and view all the answers

    For which patient population are lower doses of muscle relaxants recommended due to potential impairments?

    <p>Patients with renal impairment</p> Signup and view all the answers

    What is the maximum recommended daily dose of tizanidine for spasticity?

    <p>$36$ mg per day</p> Signup and view all the answers

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