88B Mood stabilizers

Question 1

Mood stabilizer treats…

Answer 1

manic episodes

depressive episodes without precipitating mania (unlike antidepressants)

Prevents manic and depressive episodes

Question 2

Antidepressants in bipolar conditions

Answer 2

Use with caution

Don’t treat manic episodes

can cause mania in bipolar patients

Question 3

Mood stabilizers mechanism of action

Answer 3

Not completely understood

decreases glutamate activity (excitatory)

increases GABA activity (inhibitory)

Question 4

3 types of mood stabilizers

Answer 4

1) lithium
2) anticonvulsants
3) antipsychotics

Question 5

Lithium mechanism

Answer 5

Not understood

not synaptic

via Intracellular signal transduction systems –> alters several nts

Question 6

Lithium - kinetics

Answer 6

Excreted unchanged by kidney

not protein bound

no hepatic metabolism

half life of 24 hours (5 days for steady state)

Question 7

Lithium - dosing, monitoring

Answer 7

1-3 times/day (3 = better tolerance to SA)

check serum levels after 5 days of change 12 hours post dose

TI .6 to 1.2 mEq/L – just a guide for dosing

monitor BUN, creatine, CBC, EKG, Thyroid

Question 8

Lithium side effects - organ systems

Answer 8

Renal

CNS

Endocrine

Cardiac

GI

Others

Question 9

Lithium - renal effects

Answer 9

impairs concentrating ability of kidney + blocks ADH activity –> polyuria and polydipsia; diabetes insipidus

Interstitial nephritis and impaired GFR

Question 10

Lithium - CNS effects

Answer 10

sedation

impaired cognition

tremor (treat with b-blocker)

ataxia

Question 11

Lithium - Cardiac Effects

Answer 11

conduction issues –> sinus bradycardia and SA block

Question 12

what birth defect does lithium cause?

Answer 12

Ebstein’s anomaly (dysplastic tricuspid vavle)

Question 13

Drugs that increase serum lithium levels

Answer 13

NSAIDs

Thiazides

Spironlactone

Triamterene

ACE Inhibitors

Ca-channel blockers

Question 14

lithium toxicity levels occur as low as ?

Answer 14

1.5

Question 15

risk with lithium toxicity

Answer 15

permanent neurologic and renal damage –> death

Question 16

Lithium- what is mild vs moderate toxicity

Answer 16

<2 = mild

>2 = moderate - severe - very severe (>3)

Question 17

lithium toxicity management

Answer 17

mild - stop drug, rehydrate with normal saline

severe - dialysis

Question 18

Lithium toxicity causes

Answer 18

drug interaction

dehydration/decreased sodium intake/decreased renal blood flow (heart failure, cirrhosis)

Question 19

lithium - clinical use

Answer 19

bipolar mania + maintenance (and bipolar depression)

mania > bipolar depression (better than other mood stabilizers though)

takes 1-3 weeks to treat mania though so use another mood stabilizer (or add on)

Usually use mulitple durgs in bipolar

reduces suicide risk

Question 20

Who is lithium less effective in?

Answer 20

mixed mood episodes

rapid cycling

comorbid substance abuse

Question 21

Anticonvulsant mechanism of action in bipolar treatment

Answer 21

blocks voltage gated Ca channels and other channels

enhances GABA activity or decreases glutamate activity

Question 22

list commonly used anticonvulsants in bipolar

Answer 22

Valproic acid (acute mania - most effective and quick)

carbamazepine

oxcarbazepine

lamotrigine

Question 23

Valproic Acid - use

Answer 23

acute mania and maintenance mania

works quickly

less effective for bipolar depression

Question 24

valproic acid metabolism

Answer 24

liver

can increase P450 drug levels (lamotrigine)

Question 25

valproic acid side affects

Answer 25

weight gain

GI

sedation

polycystic ovarian disease

hepatotoxicity –> check LFT

pancreatitis

thrombocytopenia –> check CBC

NTD

Question 26

Carbamazepine use

Answer 26

acute mood episodes and maintenance

mania>depression

Question 27

carbamazepine - metabolism

Answer 27

Induces P450 enzymes - can decrease levels of other drugs (Oral contracetives, warfaring, anticonvulsant)

Question 28

Lamotrigine - use

Answer 28

maintenance

depression >> acute mnaia

Question 29

lamotrigine - metabolism

Answer 29

no affect on other drugs

inhibited by valproic acid

no need for regular lab test - low SA