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Benzo and Mood Stabilizers Flashcards

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1
Q

What are the properties of benzos?

A

Anxiolytic

Hypnotic

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2
Q

What do anxiolytic agents do?

A

Reduces anxiety and produces a calming effect with little effect on motor and mental functions
Decreases activity, moderates excitement, and calms

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3
Q

What do hypnotic agents do?

A

Produces drowsiness and facilitates the onset and maintenance of a state of sleep

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4
Q

How is GABA modulated?

A

Allosterically modulated by a number of nearby receptors

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5
Q

What is the MOA for benzos?

A

Increase the frequency of Cl channel opening through allosteric modulation, allowing influx of Cl ions

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6
Q

How do benzos enhance GABA’s effect?

A

Allosterically modulates the GABA A receptor binding site, which in turn modulates the chloride channel

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7
Q

What are the most common SEs of typical benzo use?

A 
Sedation
Drowsiness
Memory difficulties
Fatigue
Muscle relaxation/weakness
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8
Q

What are the side effects of an overdose of benzos?

A 
Over sedation
Confusion
Dysarthria
Diplopia
Ataxia
Lethargy
Dizziness
Difficulty breathing
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9
Q

What are the contraindications/wanrings to benzos?

A 
Hypersensitivity
Acute narrow angle glaucoma
Sleep apnea
Severe respiratory insufficiency
Use of concomitant CNS depressants
Patients with h/o drug dependence
Abrupt withdrawal
Falls and mental alertness
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10
Q

What are benzo withdrawal symptoms?

A 
Anxiety
Agitation
Insomnia
Restlessness
Muscle tension
Irritability
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11
Q

What is considered long term use of benzoes?

A

1+ years

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12
Q

If a patient is using benzos for at least 2-6 months, what is the tapering schedule for discontinuation?

A

Slow taper by decreasing dose 10-25% every 4 weeks

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13
Q

What part of benzo withdrawal is paramount?

A

Patient education and careful monitoring

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14
Q

What is the MOA of anxiolytics?

A

5-HT1a partial agonist

5-HT2 agonist

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15
Q

What is an anxiolytic?

A

Buspirone

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16
Q

What is the onset of buspar?

A

Delayed (2+ weeks)

Don’t use PRN

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17
Q

What is Buspar approved for?

A

Approved for GAD

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18
Q

What is Buspar off label for?

A

Depression augmentation

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19
Q

Which drugs are key mood stabilizers?

A 
Lithium
Valproate
Carbamazepine
Oxcarbazepine
Lamictal
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20
Q

Which drugs are other agents that work as mood stabilizers?

A

Pregabalin
Gabapentin
Keppra
Topiramate

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21
Q

Which mood stabilizer were not shown to have an increased risk of suicidality?

A

Lithium

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22
Q

Which mood stabilizers are NTIs?

A

Lithium

Carbamazepine

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23
Q

What is lithium’s mechanistic consideration?

A

Alter cation transport
Neurotransmitter reuptake
Effects on second messenger systems

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24
Q

How is lithium adjusted?

A

CrCl < 50 (but must be stable)

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25
Q

When are lithium troughs drawn?

A

8-12 hours post dose

26
Q

What is the therapeutic range for lithium in acute mania?

A

0.8-1.2

27
Q

What is the therapeutic range for lithium for prophylaxis?

A

0.6-1.0

28
Q

What baseline labs must be taken before lithium treatment?

A

BUN, SCr, Thyroid function tests, ECG if patient > 40 or hx, CBC

29
Q

What are the most common SE of Lithium?

A 
Thirst
Increased urination
Tremor
Wt gain
Acne
Hypothyroid
WBC elevation
30
Q

What are neurologic toxicity symptoms of lithium?

A

Coarse tremor
Ataxia
Confusion
Visual changes

31
Q

What drugs increase Li levels?

A

NSAIDS
ACE/ARB
NonDHP CCBs
Thiazide

32
Q

What drugs possibly decrease Li levels?

A

Loops
Caffeine
Theophylline

33
Q

What drugs have an MOA of voltage-sensitive sodium channel (VSSCa) antagonism?

A

VPA
CBZ
Lamictal

34
Q

When do we draw valproate troughs?

A

1 hour prior to next dose

35
Q

What drug decreases VPA levels?

A

CBZ

36
Q

What are the SE of VPA?

A 
Anorexia
Decreased plts
Liver impairment
Tremor
Wt gain
Hair loss
37
Q

What enzymes does CBZ induce?

A 
3A4
1A2
2C9
2C19
2C8
Pgp
38
Q

Which drug autoinduces its own metabolism?

A

CBZ

39
Q

What genetic testing is necessary for CBZ?

A

HLA-B*1502 for SJS and TENs

40
Q

What are the SEs of CBZ and OxCBZ?

A 
GI upset
Aplastic anemia
LFT elevation
Reduced efficacy of contraceptives
Hyponatremia
41
Q

How does OxCBZ compare to CBZ?

A

May be less sedating, less bone marrow toxicity, less 3A4 interactions, no autoinduction

42
Q

What drug reduces lamotrigine levels?

A

Estrogen contraceptives

43
Q

How do we titrate lamotrigine in bipolar disorder?

A

Slowly over weeks to help prevent rash

44
Q

What is the titration schedule for lamictal in BD?

A

25mg QD x 2 weeks
50mg QD x 2 weeks
100 mg QD x 1 week
200mg QD

45
Q

What do we do to the lamictal dose if that patient is taking VPA?

A

1/2 the dose

46
Q

What do we do to the lamictal dose if the patient is taking CBZ

A

2x the dose

47
Q

What are the SEs of lamictal?

A

Rash (SJS/TENs)

48
Q

How much is VPA bound to protein?

A

80-95%

49
Q

What is the use of topamax?

A

Bipolar adjunct (not to be used alone)

50
Q

What are the SEs of topamax?

A

Dizziness, ataxia, somnolence, psychomotor slowing, memory difficulties, fatigue, decreased concentration, confusion

51
Q

What is the MOA of pregabalin and gabapentin?

A

VSSCa Alpha-2-delta ligands

52
Q

What are gabapentin and pregabalin used for?

A

Anxiety

53
Q

What are the SE of pregabalin?

A

Dizziness

Cognitive impairment

54
Q

What adjustments are needed for gabapentin?

A

Renal

55
Q

What is the SE of gabapentin?

A

Dizziness

56
Q

How is Keppra dose adjusted?

A

Renally

57
Q

What are the SEs of keppra?

A

Behavioral sx
Somnolence
HA
Hostility

58
Q

How should Li be monitored?

A 
CBC
ECG
Thyroid
SCr, BUN
TDM
Wt
Serum Ca
Urine specific gravity
UA
UO
Diet
59
Q

What should be monitored with VPA?

A 
CBC
LFT
SCr, BUN
TDM
Wt
Na
K
Ammonia
PT
Bone marrow suppression
60
Q

What should be monitored with LMTG?

A 
CBC
LFT
SCr, BUN
TDM
Wt
Rash
61
Q

What should be monitored with CBZ/OxCBZ?

A 
CBC (CBZ only)
ECG
LFT
Thyroid
SCr, BUN
TDM
HLA-B*1502

Psych (9 decks)

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