Day # 62: Review Quiz -> Anxiety/Bipolar Disorders

Today will be our first review quiz for the anxiety disorder theme. We will also include questions from the last few posts in the bipolar disorder theme. Take a few minutes and check your learning.

1) Which of the following is NOT one of the mechanisms of action for lamotrigine?

a) Blocks voltage-dependent sodium channels.

b) Potentiates GABA.

c) Some inhibition of serotonin reuptake.

d) Inhibits release of glutamate and aspartate

2) Which of the following can cause serious bone marrow suppression and can leak to leukopenia, aplastic anemia, thrombocytopenia, and agranulocytosis?

a) Lithium

b) Valproic Acid

c) Lamotrigine

d) Carbamazepine

e) Topiramate

3) Which of the following is incorrectly paired in the mnemonic "Worried WWARTS" for criteria of generalized anxiety disorder?

a) Worried

b) Wound up = irritability

c) Weirded out = paranoid

d) Absent-minded = impaired concentration

e) Restless

f) Tense = muscle tension

g) Sleepless = insomnia

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Answers

DON'T LOOK UNTIL YOU HAVE FINISHED THE ENTIRE QUIZ

Question 1:

From day #57:

Answer: c

Lamotrigine does not potentiate GABA. *Topriamate potentiates GABA*

Explanation:

Lamotrigine's mechanism of action includes:

• Blocks voltage-dependent sodium channels.

• Inhibits release of glutamate and aspartate.

• Also has some inhibition of serotonin reuptake and increases serotonin concentrations.

• Delayed onset of action (weeks) due to required slow up-titration.

Question 2:

From day #58:

Answer: d

Carbamazepine.

Explanation:

Common side effects of carbamazepine include:

• Sedation (oxcarbazepine is less sedating)

• GI upset

• Dizziness and ataxia

• Vertigo, blurred vision

• Weight gain

• Benign rash

• SIADH

Serious side effects of carbamazepine include:

• Bone marrow suppression: Can lead to leukopenia, aplastic anemia, thrombocytopenia, and agranulocytosis. There is a black-box warning for aplastic anemia and agranulocytosis.

• Rare serious rash = Stevens Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN). Severe skin and systemic reaction that exists on a spectrum (TEN more severe than SJS). Syndrome includes fever + flu-like symptoms -> painful blistering/peeling rash -> mucous membranes (such as the mouth) are often involved -> potential complications include dehydration, sepsis, pneumonia, multiple organ failure, and death. This is urgent and treatment occurs in an ICU setting or burn unit. This potential side effect should obviously be taken very seriously, however it is very rare. Individuals with the HLA-B*1502 allele are at increased risk. The FDA recommends screening for the HLA-B*1502 allele before initiating carbamazepine in patients with Asian ancestry.

• Teratogenicity: When used during pregnancy can cause craniofacial anomalies or neural tube defects such as spina bifida.

• Intraventricular cardiac conduction delay.

• Elevation of liver enzymes, causing hepatitis.

• Increased risk for suicidality.

• Overdose-> GI upset, tremor, arrhythmia, anticholinergic affects, altered mental status (confusion, stupor). May be fatal at doses as small as two times the maximum dose. Oxcarbazepine is significantly less toxic/fatal. Overdose generally benign but characterized by sedation and ataxia.

• Contraindications include bone marrow suppression, HLAB1502 subtype, and allergy to carbamazepine/oxcarbazepine and TCAs.

Question 3:

From day #61:

Answer: c

"Weirded out = paranoia" is not one of the criteria.

Explanation:

Generalized Anxiety Disorder = Worried WWARTS

• Worried

• Wound up = irritability

• Worn out = fatigue

• Absent-minded = impaired concentration

• Restless

• Tense = muscle tension

• Sleepless = insomnia

CONCLUSION

If you want to see all of the weekly quizzes you can see them here. Next lesson we will discuss considerations for the mental status exam in patients with anxiety disorders.