4.2. Psychopharmacology - Mood Stabilizers Flashcards

1
Q

What are the Indications for Mood Stabilizers?

A
  1. Bipolar
  2. Cyclothymia
  3. Schizoaffective
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2
Q

What are the Classes of Mood Stabilizers?

A
  1. Lithium
  2. Anti-Convulsants
  3. Anti-Psychotics
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3
Q
  1. When is Lithium used?

2. What Factors predict a Positive Response to Lithium?

A
  1. Long-Term Prophylaxis of Mania and Depressive Episodes
  2. a) Prior Long-Term Response
  3. b) Family member with a Good Response
  4. c) Classic Pure Mania
  5. d) Mania is followed by Depression
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4
Q

How is Lithium used?

A
  1. Get baseline U&E’s & TSH / Check Pregnancy

2. Monitor - Goal Blood Level = 0.6-1.0 - after 5 days

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5
Q

What are the Side Effects of Lithium?

A
  1. G.I. Distress - Appetite / Nausea / Vomiting / Diarrhoea
  2. Thyroid Abnormalities
  3. Non-Significant Leukocytosis
  4. Polyuria / Polydypsia
  5. Hair Loss / achne
  6. Reduces Seizure Threshold / Cognitive Slowing
  7. Lithium Toxicity:
  8. a) Mild - N&V / Ataxia / Dizziness / Slurred Speech
  9. b) Moderate - N&V / Blurred Vision / Delirium / Syncope
  10. c) Severe - Generalized Convulsions / Renal Failure
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6
Q

What are the forms of Anti-Colnvulsants used as Mood Stabilizers?

A
  1. Valproic Acid (Depakote) - Bipolar Disorder
  2. Carbemazipine (Tegretol)
  3. Lamotrigine (Lamictal)
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7
Q

What are the Side effects of Valproic Acid?

A
  1. Thrombocytopenia and Platelet Dysfunction
  2. Nausea / Vomiting / Weight Gain
  3. Sedation / Tremor
  4. Increased Risk of Neural Tube Defects
  5. Hair Loss
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8
Q

What is Carbemazipine 1st line for?

A

Acute Mania and Mania Prophylaxis

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9
Q

What are the Side Effects of Carbemazipine?

A
  1. Rash
  2. Nausea / Vomiting / Diarrhoea
  3. Sedation / Dizziness / Ataxia / Confusion
  4. AV Condutions Delays
  5. Aplastic Anaemia and Agranulocytosis
  6. Water Retention
  7. Drug-Drug Interactions
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10
Q

What are the Side Effects of Lamotrigine?

A
  1. Nausea / Vomiting
  2. Sedation / Dizziness / Ataxia / Confusion
  3. Rash - Toxic Epidermal Necrolysis / SJS
  4. Blood Dyscrasias
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11
Q

What are the Indications for using Antipsychotics?

A
  1. Schizophrenia
  2. Schizoaffective Disorder
  3. Bipolar Disorder - for Mood Stabilization +/- Psychotic Features are present
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12
Q

What causes Psychosis?

A

Key Pathways affected by Dopamine in the Brain:

  1. Mesocortical - Negative Symptoms / Cognitive Disorders arise from here - Too Little Dopamine
  2. Mesolimbic - Positive Symptoms (Hallucinations…) arise from here - Too Much Dopamine
  3. Nigrostriatal - Parkinsonian Symptoms can arise from here - Dopamine Hypoactivity
  4. Tuberoinfundibular - Hyperprolactinaemia Symptoms - Too Much Dopamine
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13
Q

How do Typical Antipsychotics work?

A

D2 Dopamine Receptor Antagonists:

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14
Q

What are the Types of Typical Antipsychotics?

A
High D2-Receptor Affinity:
1. Haloperidol
2. Primozide
3. Fluphenazine
Low D2-Receptor Affinity:
1. Chlorpromazine
2. Thioridazine
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15
Q

How do Atypical Antipsychotics work?

A

Serotonin-Dopamine 2 Antagonists (SDA’s)

Note - Hit D1, D3, D4, D5 Receptors (Typical Hit D2)

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16
Q

What are the Types of Atypical Antipsychotics?

A
  1. Risperidone
  2. Olanzapine
  3. Quetiapine
  4. Aripiprazole
  5. Clozapine
17
Q

What are the Adverse Effects of Antipsychotics?

A
  1. Tardive Dyskinesia - Involuntary Muscle Movements
  2. Neuropathic Malignant Syndrome
  3. Extrapyramidal Side-Effects
18
Q

What are the Agents used for Extrapyramidal Side Effects?

A
  1. Anticholinergics - Benztrophine / Trihexyphenidyl / Diphenhydramine
  2. Dopamine Facilitators - Amantadine
  3. Beta-Blockers - Propanolol
19
Q

What are Anxiolytics used to treat?

A
  1. Panic Disorder
  2. Generalized Anxiety
  3. Substance-Related Withdrawal
  4. Insomnias / Parasomnias
    Note - used in combination with SSRI’s / SNRI’s
20
Q

What are the Types of Anxiolytics?

A
  1. Buspirone

2. Benzodiazapines