Bradley: Mood Stabilizers

Question 1

Valproic Acid (6)

Answer 1

1. Blocks Na channels
2. Inhibits GABA degradation
3. Can be dosed rapidly to treat acute mania
4. More effective than lithium in rapid cycling and mixed states
5. Migraine prophylaxis
6. Liver dysfunction and decreased platelets

Question 2

Carbamazepine (5)

Answer 2

1. Stabilizes inactivated state of Na channels
2. More effective than lithium in rapid cycling and mixed states
3. Multiple drug interactions either it affecting other meds (increasing their levels by decreasing their metabolism) OR other meds affecting it (increasing its levels)
4. Induces its own metabolism, so may need to adjust dose over several weeks
5. Half-life decreases to 12-17 hours

Question 3

Oxcarbazepine (4)

Answer 3

1. Tolerated Better
2. LESS BLOOD DYSCRASIAS
3. NON-SEDATIVE
4. No enzyme inducing effects of carbamazepine

Question 4

Lithium (7)

Answer 4

1. Decreases activity and function of Na/K/ATPase pump in CNS and hippocampus
2. Decrease in peak stimulus induced by cAMP and less 17-OH DHA
3. Reduces suicidality
4. Excreted through kidneys
5. Be wary of fluid intake

***6. May cause kidney or thyroid dysfunction

7. Vomiting, coarse tremor, gait instability

Question 5

Lamotrigine (4)

Answer 5

1. Inhibits Na Channel.s
2. Stevens-Johnson Syndrome –> Toxic epidermal necrolytic rash
3. Minimally sedating
4. Blocks glutamate (excitatory)

Question 6

Atypical/2nd generation antipsychotics all cause?

Answer 6

Metabolic syndrome

Question 7

Topiramate (2)

Answer 7

1. Blocks Na channels

2. Side effects: kidney stones, metabolic acidosis