3. What dosage form is available for Lithium Citrate?
a. Syrup
b. Tablet
c. Capsule
d. Sublingual
e. All of the above

4. Which of the following do you need to monitor in a patient taking Lithium?
a. TSH
b. SCr
c. LFTs
d. a & b
e. b & c

5. What medication would you use to treat a tremor in a patient taking Lithium?
a. Propranolol
b. Atenolol
c. Benztropine
d. Carbidopa/Levodopa

6. Lithium has been shown to do which of the following?
a. Resynchronize the light-dark cycle
b. Decrease the availability of serotonin
c. Release inositol monophosphatase
d. Increase the formation of cAMP
e. All of the above

7. True or False: Magnesium must have high affinity in order for Lithium to bind.
a. True
b. False

8. Therapeutic Lithium levels range from _________for an acute manic attack and from ______ for maintenance.
a. 0.5 – 1.2 mEq/L; 0.8 – 1.5 mEq/L
b. 0.8 – 1.5 mEq/L; 0.5 – 1.2 mEq/L
c. 0.8 – 1.2 mEq/L; 0.5 – 1.5 mEq/L
d. 0.5 – 1.5 mEq/L; 0.8 – 1.2 mEq/L

9. JB is a 25-year-old male presenting to the ED after jumping out of a three-story window and will be admitted to the hospital. He claims he hasn’t slept much in over a week and has been talking almost non-stop since his arrival to the ED. He does not complain of a depressed mood, has actually had a persistent elevated mood for over a week. What best describes JB’s presentation?
a. Hypomania
b. Major Depressive
c. Mania
d. Mixed Features
e. Rapid Cycling

11. Which phase of bipolar disorder is described as the ‘artistic’ state of the disorder?
a. Hypomania
b. Major Depressive
c. Mania
d. Mixed Features
e. Rapid Cycling

12. __________ is four or more mood episodes in one year while meeting criteria for at least one other mood episode.
a. Hypomania
b. Major Depressive
c. Mania
d. Mixed Features
e. Rapid Cycling

13. Which of the following medications is most appropriate in patients with suicidal ideations who have bipolar disorder?
a. Lithium
b. Valproic Acid
c. Lamotrigine
d. Carbamazepine

14. Which of the following are ways that patients can take Lithium to better tolerate it?
a. Divide the daily dose
b. Take with food
c. Use coated tablets
d. All of the above

15. _________ is NOT an initial dose-related side effect of Lithium.
a. GI distress
b. Memory impairment
c. Benign reversible leukocytosis
d. Polydipsia
e. Poor concentration

16. Signs of Lithium intoxication (levels over 2 mEq/L) include all of the following EXCEPT:
a. Hand tremor
b. Hallucinations
c. Slurred speech
d. Tardive dyskinesia
e. Coma

17. Mood stabilizers include all of the following medications EXCEPT:
a. Lithium
b. Lurasidone
c. Valproic Acid
d. Lamotrigine
e. Carbamazepine

18. ________ is superior to Lithium for a patient with rapid cycling.
a. Carbamazepine
b. Olanzapine
c. Valproic Acid
d. Lamotrigine

19. True or false: Chronic lithium administration may modulate gene expression and have neuroprotective effects.
a. True
b. False

20. True or False: Both Clozapine and Lithium reduce suicidal ideations.
a. True
b. False

21. ___________ is used for rapid cycling and __________ is used to treat depression in bipolar individuals.
a. Lamotrigine; VPA
b. VPA; lamotrigine
c. Lithium; carbamazepine
d. Carbamazepine; lithium

22. Which medication has a risk of causing aseptic meningitis?
a. Carbamazepine
b. Lithium
c. Valproic Acid
d. Lamotrigine

23. Which of the following affect serum Lithium concentrations? (select all that apply)
a. Thiazide diuretics
b. NSAIDS
c. ACE inhibitors
d. ARBs
e. Changes in salt intake

24. Which of the following is approved for use in bipolar disorder?
a. Clozapine
b. Risperidone
c. Paliperidone
d. Brexipiprazole

25. ________ is/are an appropriate treatment of acute mania in patients with bipolar disorder. (select all that apply)
a. Lithium
b. Lamotrigine
c. Valproic Acid
d. Carbamazepine

26. True or False: Lithium is not metabolized.
a. True
b. False

27. __________ is more effective in preventing a depressive episode while ________ is more effective in preventing a manic episode while used for maintenance therapy in bipolar disorder.
a. Clozapine; sertraline
b. Sertraline; clozapine
c. Lamotrigine; lithium
d. Lithium; lamotrigine

28. True or False: Lamotrigine can be used for acute mania.
a. True
b. False

29. Which medication would you NOT want to prescribe to a patient who gets headaches and is taking Lithium?
a. Indomethacin
b. Sulindac
c. Aspirin
d. Acetaminophen

30. A patient has started taking Lithium 300 mg BID and has been on it for the past 3 days. Their serum lithium level is 0.4 mEq/L. What will the patient’s new steady state range be if we increase the dose by 300 mg?
a. 0.46 – 0.81 mEq/L
b. 0.55 – 0.75 mEq/L
c. 0.61 – 0.75 mEq/L
d. 0.61 – 0.81 mEq/L

31. Which initial dosing of Lithium is LEAST appropriate?
a. 100 pound patient taking 300 mg BID
b. 150 pound patient taking 300 mg TID
c. 150 pound patient taking 450 mg TID
d. 200 pound patient taking 600 mg BID

32. A patient weighing 176 pounds is having a manic episode and needs a loading dose of valproate. What is the most appropriate recommendation?
a. 1000 mg
b. 1200 mg
c. 2000 mg
d. 3000 mg

33. What is the target valproate level for bipolar disorder?
a. 50-125 mcg/mL
b. 50-100 mcg/mL
c. 25-100 mcg/mL
d. 25-125 mcg/mL

34. JB has had hallucinations and delusions for the past two weeks without mania or depression. Which of the following is most likely for JB’s diagnosis?
a. Schizophrenia
b. Bipolar disorder
c. Epilepsy
d. Schizoaffective disorder

35. A bipolar, pregnant patient should most likely be prescribed:
a. Valproate
b. Lithium
c. Lamotrigine
d. Haloperidol

36. A patient taking Lamotrigine with Valproate should take ___________ during the first two weeks of therapy.
a. 25 mg/day
b. 25 mg every other day
c. 50 mg/day
d. 50 mg every other day

37. True or False: Patients taking Valproate should provide labs every 6 months to monitor for liver function and thrombocytopenia.
a. True
b. False

38. Carbamazepine has risks for and monitoring requirements for all of the following EXCEPT:
a. Hepatic failure
b. Kidney failure
c. Agranulocytosis
d. Aplastic anemia
e. Thrombocytopenia