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1. Which one of the following drugs is not U.S. Food and Drug Administration (FDA)-approved for the treatment of acute bipolar depression:

A. Quetiapine B. Lurasidone C. Lithium D. Olanzapine-fluoxetine combination

2. Bipolar type II disorder differs from bipolar type I disorder because

A. It includes full manic episodes B. The depressive episodes are more frequent C. The depressive episodes are less severe D. The depressive episodes are shorter in duration

3. Anhedonia is defined as which of the following:

A. Feelings of worthlessness and guilt B. Indecisiveness C. Loss of energy D. Loss of interest or pleasure in activities

4. The most important difference between bipolar depression and unipolar depression is which of the following:

A. Unipolar depression has a greater impact on social and occupational functioning B. The drug treatment options for each disorder are different C. Unipolar depressive disorder has more depressive episodes D. The diagnostic criteria and presenting symptoms for a depressive episode are different

5. Which one of the following is NOT a characteristic of how drug treatment for an episode of acute bipolar depression has changed over the past 10 years:

A. Antidepressants are no longer viewed as first-line agents B. Lamotrigine monotherapy is no longer viewed as an effective treatment option C. Several atypical antipsychotic drugs have demonstrated efficacy as monotherapy D. Recent studies of drug combinations has increased the recommended use of these medications

6. Which one of the following is TRUE regarding use of mood stabilizers for the treatment of bipolar depression:

A. Valproate has no clinical trials to support its efficacy B. Lithium is more effective than lamotrigine for preventing future depressive episodes C. Lamotrigine has the best evidence supporting its value for reducing the risk of suicide D. Lithium is a first-line treatment option for an acute bipolar depression

7. Which one of the following is NOT TRUE regarding use of antidepressants to treat bipolar depression:

A. Antidepressants have been designated as second-line treatment options and mood stabilizers and atypical antipsychotic medications are recommended more often B. If used, antidepressants must always be accompanied by a mood stabilizer C. If used, antidepressants should be discontinued once the depressive episode resolves D. Antidepressants are equally effective for unipolar and bipolar depression

8. Which one of the following is TRUE regarding the risks of using antidepressants for the treatment of bipolar depression:

A. Antidepressants carry a sevenfold increased risk of activating a manic episode for a patient with bipolar disease B. Use of a combination mood stabilizer and antidepressant does not eliminate the risk of a manic episode C. Bupropion carries a greater risk of activating a manic episode than selective serotonin reuptake inhibitors (SSRIs) D. Venlafaxine carries a lower risk of activating a manic episode than SSRIs

9. Which one of the following is TRUE regarding the use of antipsychotic medications for the treatment of bipolar depression:

A. While quetiapine and lurasidone are indicated by the FDA as monotherapy, all atypical antipsychotic drugs are believed to be effective for acute bipolar depression B. Studies investigating quetiapine and lurasidone demonstrate a rapid onset of effect, often within the first 1 to 2 weeks C. Haloperidol is the only older antipsychotic medication with proven efficacy for the treatment of bipolar depression D. Aripiprazole is the newest medication with proven efficacy for the treatment of bipolar depression

10. Which one of the following is TRUE regarding use of olanzapine-fluoxetine combination (OFC) therapy for the treatment of bipolar depression:

A. Olanzapine monotherapy and OFC are approved for the acute treatment of bipolar depression B. Compared with lamotrigine, after 6 months of treatment, OFC was less effective C. The more common side effects experienced as a result of treatment with OFC include weight gain and hypercholesterolemia D. Compared with other atypical antipsychotic medications, studies investigating OFC therapy demonstrate greater efficacy for the core symptoms of depression

11. Which one of the following is TRUE regarding use of quetiapine for the treatment of bipolar depression:

A. Doses of 600 mg/day were more effective than placebo, but the efficacy of a 300 mg/day dose was similar to that of placebo B. Quetiapine's remission rates for the treatment of depression are greater than 50%, which is similar or greater in magnitude to rates seen with antidepressant therapy for unipolar depression C. Quetiapine is more successful for the treatment of insomnia and anxiety than it is for the core symptoms of depression D. In 8-week trials, quetiapine was associated with a 3 to 6 kilogram weight gain

12. Which one of the following is TRUE regarding use of lurasidone for the treatment of bipolar depression:

A. Lurasidone is approved as both monotherapy and as an adjunct to lithium or valproate for the treatment of bipolar depression B. Doses of 80 to 120 mg/day were substantially more effective than doses of 20 to 60 mg/day C. The more common side effects seen with lurasidone include weight gain and nausea D. In clinical trials, the rate of discontinuation as the result of side effects from treatment with lurasidone were substantially greater than that of placebo

13. Which one of the following is associated with the greatest risk of weight gain and metabolic effects:

A. Aripiprazole B. Quetiapine C. Lurasidone D. Olanzapine

14. Which one of the following has a recommended starting dose of 20 mg/day for a younger healthy patient:

A. Lurasidone B. Olanzapine C. Quetiapine D. Lamotrigine

15. An enriched study design to investigate the maintenance treatment of bipolar disorder means that

A. Only patients who positively responded to the drug, acutely, are continued into maintenance therapy B. Placebo nonresponders are switched to the active drug for maintenance therapy C. Mood stabilizers are added to effective acute therapy for maintenance therapy D. Use of benzodiazepines and hypnotic drugs are added for maintenance therapy

16. Which one of the following is associated with the greatest risk of hyperprolactinemia and extrapyramidal effects:

A. Lurasidone B. Risperidone C. Olanzapine D. Quetiapine

17. Which one of the following drug classes has the strongest evidence to support its discontinuation once maintenance therapy is initiated:

A. Anticonvulsant mood stabilizers B. Atypical antipsychotics C. Antidepressants D. Lithium

18. Approximately what percentage of bipolar patients is fully adherent with their medication?

A. 10% B. 25% C. 50% D. 75%

19. Among bipolar patients nonadherent with their medication, what percentage is the result of side effects?

A. 5% B. 20% C. 40% D. 70%

20. Important information pharmacists should mention while counseling their patients with bipolar illness include all but which one of the following:

A. Combination therapy involving medications from several drug classes is often appropriate in the treatment of bipolar disorder B. Most individuals with bipolar disorder will benefit from maintenance therapy once acute symptoms are treated to avoid symptom recurrence C. Atypical antipsychotic medications should not be referred to as antipsychotic medications when used to treat an individual with bipolar depression D. Counseling should focus on possible side effects, since side effects are the most common cause for nonadherence with medication