Bipolar Disorders (mood stabilizers)

Question 1

Lithium

Answer 1

Brand: Tablets + ER forms
Dosage: 300-1200mg/day (BID + TID)
Class: Lithium (alters Na-transport)
CIs: Significant renal/cardiovascular disease, dehydration
SEs: D/N/V, drowsiness, muscle weakness, ataxia, blurred vision, tinnitus
Monitoring: Serum Concentrations 06.-1.5mEq/L
Drug Interactions: ACEi + TZDs (decreased clearance)

Question 2

Valproic Acid/Divalproex

Answer 2

Brand: Depakote, Depakene, Depacon
Dosage: 10-60mg/kg/day
Class: increase brain [GABA]
CIs: Hepatic dysfunction, hypersensitivity, urea cycle disorders
SEs: Hepatic disease, thrombocytopenia, hyperammonemia, wt gain, pancreatitis
Monitoring: Serum concentration 50-100mcg/mL, LFTs, periodic CBC + serum ammonia
Other: Highly teratogenic, many dosage forms, drug interactions

Question 3

Oxcarbazepine

Answer 3

Brand: Trileptal (tabs + oral suspension)
Dosage: 600-2400mg/day (BID)
Class: Blocks voltage-sensitive NaC
CIs: Hypersensitivity
SEs: Sedation dizziness, ataxia, N/V, rash (stevens-johnson), hyponatremia
Monitoring: Na, renal function, serum concentration 12-30mcg/mL
Other: CrCl

Question 4

Lamotrigine

Answer 4

Brand: Lamictal
Dosage: 25-700mg/day (BID)
Class: Stabilizes sodium channels
CIs: Hypersensitivity, Hx Stevens-Johnson
SEs: Stevens-Johnson, rash (other), diplopia, dizziness, headache
Monitoring: Tx response, side effects
Other: Slow titration required, valproate combo rash (possible)