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Pharm - Psychiatry > Bipolar - Anticonvulsants > Flashcards

Bipolar - Anticonvulsants Flashcards

1
Q

Name the 4 Drugs in this Category

A

Valproic Acid (VPA)
Sodium Valproate (Depakote)
Carbamazepine
Lamotrigine

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2
Q

VPA

vs. Sodium Valproate/Divalproex Sodium (Depakote)

A

VPA is a liquid that gives GI issues

Depakote is a powder that has half Sodium Valproate and is enterically coated to lessen GI issues

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3
Q

Depakote PK:
Absorption?
Protein Binding?

A

100% absorbed

90% protein bound (high) but may be displaced by other drugs (or displace other drug bound proteins)

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4
Q

VPA and Depakote Indications

A

First line for bipolar mania

Bipolar Maintenance

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5
Q

Relation between drug level and response for VPA/Depakote

A

For MANIC episodes:

Response increases as drug level increases

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6
Q

DDI between VPA/Depakote and Phenytoin

A

Displaces Phenytoin (anti-epileptic) and increases its levels giving possible toxicity

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7
Q

DDI between VPA/Depakote and Aspirin/Caffeine

A

Aspirin and caffeine displace VPA/Depakote from serum proteins and give inc risk of toxicity

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8
Q

Effect of VPA/Depakote on hepatic metabolism

A

Inhibits hepatic metabolism

Affects metabolism of phenytoin, phenobarbital, and carbamazepine

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9
Q

VPA/Depakote with Lamotrigine gives?

A

Inhibited phase 2 glucoronidation of Lamotrigine (so lamotrigine levels increase)

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10
Q

VPA/Depakote: Common Side Effects (6)

A 
Nausea
Vomiting
Diarrhea
Tremor
Sedation
Weight Gain
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11
Q

VPA/Depakote: Rare Side Effects

A

Alopecia
Dec Platelets (Thrombocytopenia) - seen more at higher doses
Inc suicide risk
Pancreatitis

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12
Q

Effect of VPA/Depakote on Ammonia Level

A

Increased Ammonia level

Can give encephalopathy or delirium if severe

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13
Q

VPA/Depakote Toxicity

A

Mild Inc LFT’s (reversible)

Hepatotoxicity (more with kids

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14
Q

Carbamazepine Protein Binding

A

Medium

70-80%

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15
Q

Carbamazepine DDI’s - does it affect CYP450? If so, how?

A

Induces CYP450 and gives inc metabolism of other drugs

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16
Q

Carbamazepine and Depakote DDI

A

Depakote can bump Carba off protein binding site

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17
Q

Carbamazepine DDI’s

A

Other drugs can inhibit OR induce it’s metabolism

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18
Q

Carbamazepine DDI’s - Glucuronidation?

A

Induces UDP-glucuronosyltransferases

19
Q

Carpamazepine and CYP450 3A4 Inhibitors

A

CYP450 3A4 Inhibitors (fluoxetine, cimetidine, erythromycin, isoniazid) give inc levels of carba

20
Q

Carbamazepine’s effect on itself?

A

Auto-induces it’s own metabolism

Half life goes from 24 to 8 hours

21
Q

Carpamazepine and CYP450 3A4 Inductors

A

CYP450 3A4 Inductors (phenobarbital, phenytoin, primodone) give dec levels of carba

22
Q

Carbamazepine metabolism - renal or hepatic?

A

Hepatic

23
Q

Carbamazepine - Rare Side effects

A 
Stevens Johnson Syndrome
Hepatotoxicity
Aplastic Anemia
Agranulocytosis
Inc Suicide Risk
24
Q

Carbamazepine - Teratogenic?

A

Yes, gives inc risk of neural tube defects (via epoxide metabolite of drug)

25
Q

Carbamazepine - Common Side effects

A

Nausea
Dizziness
Sedation

26
Q

Stevens Johnson Sydrome - population affected?

A

Seen more in Asian ancestry with HLA-B 1502

27
Q

Lamotrigine IS NOT used for?

A

Acute manic episode

28
Q

Lamotrigine Indications

A

Bipolar depression

Bipolar long-term maintenance

29
Q

Lamotrigine PK:

Protein Binding

A

Low protein binding (55%)

30
Q

Lamotrigine Metabolism

A

via Glucuronidation

31
Q

Lamotrigine and Sodium Valproate (Depakote)

A

Sodium Valproate (Depakote) can double Lamotrigine’s plasma levels

32
Q

Lamotrigine and Oral Contraceptives

A

Oral Contraceptives can cut the Lamotrigine level in half

33
Q

Lamotrigine and Carbamazepine (or CYP3A4)

A

Gives inc metabolism of Lamotrigine and dec plasma level of Lamotrigine

34
Q

Lamotrigine - Rare Side Effects

A 
Stevens Johnson Syndrome
Blood Dyscrasias (agranulocytosis/ aplastic anemia)
35
Q

Lamotrigine - Common Side Effects

A

Benign Rash!

Nausea

36
Q

Majority of Stevens Johnson Syndrome occurs within how many weeks?

A

8 weeks

37
Q

What other drugs besides lithium and anticonvulsants can be used for bipolar disorder?

A

Second Generation Antipsychotics

38
Q

Of Acute Mania, Maintenance, Bipolar Depression - which ones are treated by Valproic Acid/VPA

A

Acute Mania and Maintenance

39
Q

Of Acute Mania, Maintenance, Bipolar Depression - which ones are treated by Carbamazepine

A

Acute Mania and Maintenance

40
Q

Of Acute Mania, Maintenance, Bipolar Depression - which ones are treated by Lamotrigine

A

Maintenance and Bipolar Depression

41
Q

Which drug has the greatest potential for serious birth defects?

A

VPA (Valproic Acid) and Sodium Valproate/Depakote

Neural tube defect of 1-2% is 10-20x’s the general population rate

42
Q

Carbamazepine issues during pregnancy

A

Increased risk of neural tube defect/spina bifida

43
Q

When is there an increased risk of manic episodes in relation to pregnancy?

A

During pregnancy and in the post-partum period

44
Q

Lamotrigine issues during pregnancy

A

Increased risk of cleft lip or palate

Pharm - Psychiatry (6 decks)

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