Anti-mania Drugs PSYCH Flashcards
Name 3 big classes of mood stabilizer/ anti-mania drugs
- Lithium carbonate
- Anti-convulsants
- Anti-pschotics
Which drug is the only one that can be used as effective monotherapy
Lamotrigine
What is the risk of using anti-depressive as monotherapy for bipolar disorder
Trigger manic episoides
Lithium can be used in combination with
anti-depressants
Lithium carbonate
Class Dynamics or Mechanism Kinetics Side Effects BBW DDI Overdose symptoms Special considerations Special pops to avoid
Class
• Anti-mania
• Mood stabilizer
• Cluster Headache (HA) prophylaxis
Mechanism
• Unknown
• Alter Na transport in neurons
Kinetics
• Unchanged
Side effects • 1st weeks • Blurred vision • Tremble in hands • Reversible nephrogenic DI • Polyuria • Polydipsia • Weight gain • Drowsiness • Thyroid fun.
BBW
Toxicity can occur at doses similar to therapeutic dose – monitor serum levels closely
DDI Drugs that alter blood volume • Diuretics • NSAIDS • ACE inhibs. • Ca blockers
Overdose • Ataxia • Vomiting diarrhea • Vomiting • nausea
Special population • Never double dose • Brugada Syndrome • Pregnancy • HTN • Elderly • Renal impairment • Brugada syndrome • Volume deplete • CDV • Thyroid disorder • Alcohol use • CNS depressants
Why do you have to be careful when prescribing lithium
VERY narrow therapeutic range so sensitive to changes in blood volume i.e. diarhia, CHF, CDV, renal impairement…
Valproic Acid
Class Dynamics or Mechanism Clearance Side Effects BBW DDI Monitor
Class • Anti-convulsant • Mood stabilizer • Absence seizures • HA prophylaxis
Dynamics or Mechanism • Unknown • Inc GABA • Dec Glutamate/NMDA • Inhibit histone deacetylase 1
Clearance
Hepatic
Side Effects • Hepatotoxicity • Teratogenic • Pancreatitis • Weight gain • Polycystic ovary syndrome • Hair loss
BBW
• Hepatotoxicity
• Teratogenic
• Pancreatitis
DDI
• Reduces clearance or carbamazepine and lamotrigine
Monitor Baseline • CBC differential • LFT • Pregnancy test • Liver function • CBC differentia • Ovaries
Carbamazepine
Class Dynamics or Mechanism Clearance Side Effects BBW DDI Monitor Special population
- Focal seizures
- 2nd generalized
- Neuropathic pain
- Trigeminal neuralgia
Mechanism
• Na blocker
Clearance
• Hepatic
SE • Drowsiness • Headaches • Migraine • Coordination • GI distress • Alcohol intolerance • Weight gain • Aplastic anemia
BBW
• Influence activity & metabolism of other drugs
• HLA-B1502 allele (Asian communities) aplastic anemia
Drugs that alter blood volume
DDI • Diuretics • NSAIDS • ACE inhibs. • Ca blockers
Monitor
Baseline
• CBC differential
Special populations • Brugada syndrome • Pregnancy • HTN • Elderly • Renal impairment • Brugada syndrome • Volume deplete • CDV • Thyroid disorder • Alcohol use • CNS depressants
Lamotrigine
Class Mechanism Clearance SE BBW DDI Special populations
Class • Anti-convulsant • Mood stabilizer • Same class as carbamazepine • Depressed phase of bipolar
Mechanism
• Na blocker
• Decrase Glutamate
Clearance
• Hepatic
SE • Skin rash • Fever • Fatigue • Stevens-Johnson Syndrome • DRESS syndrome • Aseptic meningitis • Epidermal necrolysis
BBW
• Rash
• Steven-Johnson Syndrome
DDI
Very few
Special populations
• Pregnancy
Oxcarbazepine
Class Mechanism Clearance SE DDI Monitor
Class Class • Anticonvulsant • Mood stabilizer • Similar to carbamazepine • Preferred anti-psychotic in in pregnancy
Mechanism
• Na blocker
Clearance
Unchanged
SE • Dizziness • Blurred vision • Fatigue • HA • Nausea • Vomiting • Cognitive impairment • Hyponatremia
DDI
Similar to carbamazepine but less likely to alter metabolism of other drugs
Monitor • Baseline Na • Depression • Behavior changes • Suicidality
Olanzapine
Class Mechanism Clearance SE BBW Monitor
Class
• Atypical anti-psychotic
• Mood stabilizer
Mechanism
• Blocks 5HT2A
• D2 receptor
Clearance
• Hepatic
SE • Drowsiness • Flu • Weight gain • Salivation • Tardive dyskinesia • QTc prolongation
BBW
Not indicated for dementia related Psychosis
Monitor • Glucose • Lipids • LFT • CBC • Weight • Orthostatic hTN id used IM
Anti-mania drug also good for abscense seizure
Valproic acid
Anti-mainia/convulsant which reduces the clearnce of carbamazepine and lamotrigine
Valproic acid
Anti-mainia/convulsant that has apalstic anema as a side effect of aplastic anemia
Carbamazepine especially in • HLA-B1502 allele (Asian communities)
Anti-mainia/convulsant that has severe skin rash & aseptic menigitisas a side effect but has few drug drug interactions
Lamotrigine
