MCQ Quiz: Management of Bipolar Disorder

The management of bipolar disorder is a core component of patient care, preparing students to serve as collaborative interprofessional team members who are authorities on pharmacotherapy. This quiz is designed to test knowledge on providing patient-centered care for individuals with bipolar disorder, focusing on the development, integration, and application of knowledge from foundational and clinical sciences through case-based scenarios.

1. A patient is experiencing an acute manic episode. Which medication is considered a first-line agent for managing this condition?

• A. Lamotrigine
• B. Lithium
• C. Fluoxetine
• D. Buspirone

Answer: B. Lithium

2. Which mood stabilizer requires a slow titration schedule to minimize the risk of a serious dermatological reaction, such as Stevens-Johnson Syndrome?

• A. Lithium
• B. Valproic Acid
• C. Lamotrigine
• D. Topiramate

Answer: C. Lamotrigine

3. The combination of olanzapine and fluoxetine is FDA-approved for the management of which condition?

• A. Acute mania
• B. Bipolar depression
• C. Generalized anxiety disorder
• D. Rapid-cycling bipolar disorder

Answer: B. Bipolar depression

4. According to the “Study Aid Table” for mood stabilizers, which of the following is a critical laboratory parameter to monitor for a patient on long-term lithium therapy?

• A. Liver function tests
• B. Complete blood count
• C. Thyroid Stimulating Hormone (TSH)
• D. Serum amylase

Answer: C. Thyroid Stimulating Hormone (TSH)

5. Which of the following second-generation antipsychotics is specifically listed in the syllabus as being FDA-approved for manifestations of bipolar disorder?

• A. Haloperidol
• B. Chlorpromazine
• C. Quetiapine
• D. Thioridazine

Answer: C. Quetiapine

6. A patient with bipolar disorder should be counseled that using an antidepressant as monotherapy carries a significant risk of:

• A. Causing severe sedation.
• B. Inducing a switch into mania or hypomania.
• C. Leading to hypertensive crisis.
• D. Being ineffective for depressive symptoms.

Answer: B. Inducing a switch into mania or hypomania.

7. Valproic acid, a commonly used mood stabilizer, has a black box warning for which severe adverse effect?

• A. Agranulocytosis
• B. Hepatotoxicity
• C. Nephrotoxicity
• D. Cardiotoxicity

Answer: B. Hepatotoxicity

8. Which medication is generally considered more effective for preventing depressive relapses rather than manic relapses in the maintenance phase of bipolar disorder?

• A. Risperidone
• B. Lithium
• C. Valproate
• D. Lamotrigine

Answer: D. Lamotrigine

9. The primary goal of the maintenance phase in managing bipolar disorder is to:

• A. Find the lowest effective dose.
• B. Prevent the recurrence of future mood episodes.
• C. Taper the patient off all medications.
• D. Treat acute symptoms of mania.

Answer: B. Prevent the recurrence of future mood episodes.

10. What is the typical therapeutic serum concentration range for lithium during the maintenance phase of treatment?

• A. 0.2-0.5 mEq/L
• B. 0.6-1.0 mEq/L
• C. 1.2-1.5 mEq/L
• D. >1.5 mEq/L

Answer: B. 0.6-1.0 mEq/L

11. Which mood stabilizer is also an anticonvulsant and a potent inducer of CYP3A4 enzymes, leading to numerous drug interactions?

• A. Lamotrigine
• B. Gabapentin
• C. Valproic acid
• D. Carbamazepine

Answer: D. Carbamazepine

12. The mechanism of action for second-generation antipsychotics (SGAs) in bipolar disorder involves modulation of which two neurotransmitter systems?

• A. GABA and glutamate
• B. Acetylcholine and histamine
• C. Dopamine and serotonin
• D. Norepinephrine and epinephrine

Answer: C. Dopamine and serotonin

13. A patient stabilized on valproic acid is started on lamotrigine. How should the lamotrigine dose be initiated?

• A. At the standard starting dose.
• B. At a higher starting dose due to induction.
• C. At a lower starting dose and titrated more slowly due to valproate’s inhibition of lamotrigine metabolism.
• D. With a loading dose.

Answer: C. At a lower starting dose and titrated more slowly due to valproate’s inhibition of lamotrigine metabolism.

14. Lurasidone is an atypical antipsychotic that is FDA-approved for the treatment of:

• A. Acute mania as monotherapy.
• B. Bipolar depression as monotherapy.
• C. Agitation associated with mania.
• D. Prophylaxis of manic episodes.

Answer: B. Bipolar depression as monotherapy.

15. A key counseling point for a patient starting lithium is to maintain consistent intake of:

• A. Tyramine and vitamin K.
• B. Grapefruit juice and dairy.
• C. Salt and fluids.
• D. High-fat foods.

Answer: C. Salt and fluids.

16. Which of the following is a common, dose-related side effect of valproic acid that requires monitoring of a complete blood count (CBC)?

• A. Thrombocytosis
• B. Thrombocytopenia
• C. Leukocytosis
• D. Anemia

Answer: B. Thrombocytopenia

17. The Pharmacists’ Patient Care Process (PPCP) is a systematic approach to patient-centered care. What is the first step in this process when managing a patient with bipolar disorder?

• A. Plan
• B. Implement
• C. Assess
• D. Collect

Answer: D. Collect

18. A patient on an SGA like olanzapine should be routinely monitored for which of the following?

• A. Hypoglycemia and weight loss
• B. Hyperglycemia, weight gain, and dyslipidemia
• C. Thyroid dysfunction
• D. Renal dysfunction

Answer: B. Hyperglycemia, weight gain, and dyslipidemia

19. What is the primary role of benzodiazepines in the management of acute mania?

• A. Long-term mood stabilization.
• B. Treatment of underlying psychosis.
• C. Short-term adjunctive treatment for agitation and insomnia.
• D. Prevention of depressive relapse.

Answer: C. Short-term adjunctive treatment for agitation and insomnia.

20. A pharmacist is creating a care plan for a patient with bipolar disorder. According to the PPCP, this plan should be patient-centered and developed in collaboration with the patient and other health professionals. What is the next step after creating the plan?

• A. Collect
• B. Assess
• C. Implement
• D. Follow-up

Answer: C. Implement

21. A patient with bipolar disorder reports that their first-ever episode was depressive. This clinical presentation is:

• A. Rare and atypical for bipolar disorder.
• B. A common initial presentation, which can make diagnosis difficult.
• C. Indicative of Bipolar II disorder only.
• D. A contraindication for using lithium.

Answer: B. A common initial presentation, which can make diagnosis difficult.

22. Which mood stabilizer is associated with a risk of polyuria and polydipsia due to its effects on the kidney’s response to antidiuretic hormone (ADH)?

• A. Valproic acid
• B. Lamotrigine
• C. Lithium
• D. Carbamazepine

Answer: C. Lithium

23. The development of a fine tremor is a common side effect associated with the initiation of which mood stabilizer?

• A. Lamotrigine
• B. Valproic acid
• C. Carbamazepine
• D. Lithium

Answer: D. Lithium

24. For a patient with bipolar disorder experiencing a depressive episode, which of the following is an FDA-approved monotherapy option?

• A. Sertraline
• B. Bupropion
• C. Quetiapine
• D. Aripiprazole

Answer: C. Quetiapine

25. A female patient of childbearing age is to be started on valproic acid. What is the most critical counseling point?

• A. The medication can cause weight loss.
• B. The medication is highly teratogenic and effective contraception is essential.
• C. The medication should be taken on an empty stomach.
• D. The medication must be titrated slowly to avoid a rash.

Answer: B. The medication is highly teratogenic and effective contraception is essential.

26. Carbamazepine’s property of auto-induction means that over the first few weeks of therapy, its own serum concentration will likely:

• A. Increase.
• B. Decrease.
• C. Remain stable.
• D. Fluctuate unpredictably.

Answer: B. Decrease.

27. What is a primary reason that lamotrigine is not considered a first-line agent for acute mania?

• A. It is not effective for mania.
• B. It has a high risk of metabolic side effects.
• C. The required slow titration makes it unsuitable for rapid symptom control.
• D. It must be administered intravenously.

Answer: C. The required slow titration makes it unsuitable for rapid symptom control.

28. A patient’s lithium level comes back at 1.7 mEq/L. They complain of coarse tremor, confusion, and ataxia. This is indicative of:

• A. A subtherapeutic level.
• B. A therapeutic level for maintenance.
• C. Lithium toxicity.
• D. A common, transient side effect.

Answer: C. Lithium toxicity.

29. The “Follow-up: Monitor and Evaluate” step of the PPCP involves assessing which of the following for a mood stabilizer?

• A. Only the cost of the medication
• B. The safety and effectiveness of the care plan
• C. The patient’s social media activity
• D. The pharmacist’s own job satisfaction

Answer: B. The safety and effectiveness of the care plan

30. Which of the following is a non-pharmacological strategy that is essential in the long-term management of bipolar disorder?

• A. Promoting an irregular sleep schedule.
• B. Encouraging high levels of daily stress.
• C. Psychoeducation on medication adherence and recognizing early warning signs.
• D. Avoiding all forms of psychotherapy.

Answer: C. Psychoeducation on medication adherence and recognizing early warning signs.

31. The use of an atypical antipsychotic for the maintenance phase of bipolar I disorder is an example of:

• A. An off-label use.
• B. A guideline-recommended, evidence-based strategy for many agents in this class.
• C. A strategy only for patients with comorbid anxiety.
• D. A treatment that is no longer recommended.

Answer: B. A guideline-recommended, evidence-based strategy for many agents in this class.

32. What is the most appropriate action if a patient on lamotrigine reports the development of a new, widespread rash?

• A. Increase the dose of lamotrigine.
• B. Advise the patient to apply a topical hydrocortisone cream.
• C. Advise the patient to discontinue the medication immediately and seek medical evaluation.
• D. Reassure the patient that the rash is a harmless side effect.

Answer: C. Advise the patient to discontinue the medication immediately and seek medical evaluation.

33. The assessment portion of a SOAP note for a patient with bipolar disorder would include:

• A. A list of their current medications.
• B. The pharmacist’s evaluation of the patient’s current problems and the effectiveness and safety of their medications.
• C. The patient’s vital signs.
• D. The plan for future appointments.

Answer: B. The pharmacist’s evaluation of the patient’s current problems and the effectiveness and safety of their medications.

34. A patient taking carbamazepine should have a baseline CBC checked due to the rare but serious risk of:

• A. Thrombocytopenia.
• B. Aplastic anemia and agranulocytosis.
• C. Polycythemia.
• D. Hemolytic anemia.

Answer: B. Aplastic anemia and agranulocytosis.

35. Which of the following conditions can decrease the renal clearance of lithium, leading to potential toxicity?

• A. Hypertension
• B. Dehydration
• C. Hyperthyroidism
• D. Gout

Answer: B. Dehydration

36. The management of bipolar disorder often requires lifelong treatment because it is a:

• A. An acute, self-limiting illness.
• B. A chronic and recurrent illness.
• C. An illness that only affects adolescents.
• D. An illness that can be cured with one course of medication.

Answer: B. A chronic and recurrent illness.

37. Which of the following medications has a mechanism of action that includes partial agonism at the dopamine D2 receptor?

• A. Olanzapine
• B. Quetiapine
• C. Aripiprazole
• D. Risperidone

Answer: C. Aripiprazole

38. The primary difference between Bipolar I and Bipolar II disorder is the presence of at least one full _________ episode in Bipolar I.

• A. Depressive
• B. Manic
• C. Hypomanic
• D. Anxious

Answer: B. Manic

39. When managing a patient with bipolar disorder, the pharmacist’s role includes educating the patient on their medications. This would involve discussing:

• A. Only the name of the medication.
• B. The medication’s action, proper use, expected results, and possible adverse effects.
• C. The cost of the medication only.
• D. The color and shape of the tablet only.

Answer: B. The medication’s action, proper use, expected results, and possible adverse effects.

40. A patient on valproic acid should be counseled to report which symptoms that could indicate hepatotoxicity?

• A. Increased energy and appetite.
• B. Nausea, vomiting, abdominal pain, and jaundice.
• C. A fine tremor in the hands.
• D. Increased frequency of urination.

Answer: B. Nausea, vomiting, abdominal pain, and jaundice.

41. Which SGA is associated with the highest risk of metabolic side effects (weight gain, hyperlipidemia, hyperglycemia)?

• A. Ziprasidone
• B. Aripiprazole
• C. Lurasidone
• D. Olanzapine

Answer: D. Olanzapine

42. The ultimate goal in managing bipolar disorder is to achieve:

• A. Only suppression of manic symptoms.
• B. Only treatment of depressive symptoms.
• C. Euthymia, or a stable mood state, with improved overall functioning.
• D. A complete cure after one year of treatment.

Answer: C. Euthymia, or a stable mood state, with improved overall functioning.

43. A pharmacist is asked to recommend a mood stabilizer for a patient with a history of kidney disease. Which medication should be used with extreme caution or avoided?

• A. Valproic acid
• B. Lamotrigine
• C. Lithium
• D. Quetiapine

Answer: C. Lithium

44. What is the rationale for checking a pregnancy test before initiating valproic acid in a female of childbearing potential?

• A. To ensure the patient is not pregnant due to the drug’s high risk of teratogenicity.
• B. The drug is less effective during pregnancy.
• C. The drug can cause false positive pregnancy tests.
• D. The drug’s side effects mimic the symptoms of pregnancy.

Answer: A. To ensure the patient is not pregnant due to the drug’s high risk of teratogenicity.

45. Which of the following is a key reason that adherence to medication is a challenge in patients with bipolar disorder?

• A. The medications have no side effects.
• B. Some patients miss the “highs” of hypomania/mania or dislike the side effects of medications.
• C. The medications are only taken once a year.
• D. The illness is not a serious condition.

Answer: B. Some patients miss the “highs” of hypomania/mania or dislike the side effects of medications.

46. The management of “mixed features” in a mood episode (experiencing symptoms of mania and depression simultaneously) can be particularly challenging. Which agent is often considered effective for this presentation?

• A. Lamotrigine
• B. Valproic acid
• C. Fluoxetine
• D. Bupropion

Answer: B. Valproic acid

47. In the Pharmacists’ Patient Care Process, documenting a patient encounter in a SOAP note format is part of which step?

• A. Collect
• B. Assess
• C. Plan
• D. Implement

Answer: D. Implement

48. Why is it important to obtain a family history when assessing a patient for a mood disorder?

• A. It is not important.
• B. Bipolar disorder has a strong genetic component, and a positive family history increases suspicion.
• C. It helps determine the patient’s insurance coverage.
• D. It is required by law for all pharmacy consultations.

Answer: B. Bipolar disorder has a strong genetic component, and a positive family history increases suspicion.

49. Which mood stabilizer is least likely to cause weight gain?

• A. Lithium
• B. Olanzapine
• C. Valproic acid
• D. Lamotrigine

Answer: D. Lamotrigine

50. The management of bipolar disorder is an example of chronic disease state management, which requires:

• A. A single intervention with no follow-up.
• B. A focus only on acute symptoms.
• C. A long-term collaborative relationship between the patient and the healthcare team.
• D. The pharmacist to make all decisions without patient input.

Answer: C. A long-term collaborative relationship between the patient and the healthcare team.