Anti-convulsants (Mood stabilizers) Flashcards
3 indications?
BAD, cyclothymia, schizoaffective disorder
name the 3 classes of mood stabilizers?
lithium, anticonvulsants, antipsychotics
how do we choose type of Mood stabilizer?
side effects and target sx
name 3 anticonvulsants?
valproic acid (depakote), lamotrigine and carbamazepine
what is valproic acid used for?
mania prophylaxis (better than depression prophylaxis)
which patients are most likely to have a +ve repsonse to valproic acid?
rapid cycling patients, F>M, co-morbid substance issues, co-morbid anxiety disorders
what should be done before starting valproic acid?
baseline LFTs, pregnancy test and FBC
which pts should valproic acid be avoided and WHY?
women of child-bearing age - neural tube defects
how long until steady state is achieved with valproic acid?
4-5 days
how should valproic acid be monitored?
check FBC and LFTs after 12 hours of last dose
target level of valproic acid?
50-125
name 3 side effects of valproic acid?
thrombocytopenia, N+V, weight gain, tremor
what is the 1st line treatment for acute mania/ mania prophylaxis?
carbamazepine
indications of carbamazepine?
rapid cyclers
what should be done before starting carbamazepine?
baseline LFTs, FBC abd ECG
how should carbamazepine be monitored?
steady state after 5 days - check 12 hours after last dose and repeat FBC and LFTs
goal target levels for carbamazepine?
4-12 mcg/ml
name 3 SEs of carbamazepine?
rash (very common), N+V, aplastic anaemia
indications for lamotrigine?
same as others + neuropathic pain
what should be done before starting lamotrigine?
baseline LFTs
titration of lamotrigine?
start with 25mg daily for 2 qeeks - then increase to 100mg
what is a common SE of lamotrigine and what should be done if it appears?
rash - stop tx
what could rash caused by lamotrigine indicate in severe cases?
SJS, toxic epidermal necrolysis
