Lecture 77: Moodstabilizers Flashcards

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1
Q

Mood stabilizers might treat…(3)

A

Acute mania, mania recurrence, mania OR depression w/out worsening other pole of illness

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2
Q

3 main classes of mood stabilizers

A

Lithium, anticonvulsants, antipsychotics

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3
Q

Agents approved for Bipolar I disorder by stage of illness and key drugs (5 in total, 1 repeat)

A

Acute: lithium, valproate, carbamazepine ER; maintenance: lithium, lamotrigine; acute depression: no key drugs

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4
Q

T/F: Hard to treat depression in bipolar

A

True, traditional medications can –> mania; some people try to add antidepressant to mood stabilizer but no good data

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5
Q

Therapeutic use of lithium

A

Mania, bipolar maintenance; off-label: rage, MDD, schizophrenia, anti-suicide

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6
Q

Lithium and NT signaling (2) findings…take home point?

A

Balances excitatory and inhibitory effects of various NTs, enhances 5-HT release; THESE ARE THEORIES

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7
Q

Lithium and 2nd messenger system

A

Modifies cAMP levels and down-regulates PKC via PI system

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8
Q

Lithium and neuroprotective effects (2 main)

A

Prevents cell death and apoptosis, induces neurotrophic proteins via NMDA receptors

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9
Q

Where is lithium absorbed? Protein bound? Metabolized? Excreted? Why is this important?

A

GI; not protein bound OR metabolized; excreted almost completely unchanged in urine; cannot be given to people with kidney disease

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10
Q

Stead state plasma levels in?

A

4-5 days

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11
Q

What kinds of drugs increase lithium excretion?

A

Osmotic diuretics

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12
Q

What kinds of drugs decrease lithium excretion? (3) What else can increase lithium levels (3)

A

NSAIDs, ACE inhibitors, loop diuretics; kidney disease, low Na+ diet, dehydration

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13
Q

What underlies why dehydration increases lithium? Why does this matter?

A

Li+ and Na+ compete for absorption from proximal tubules; very narrow therapeutic window

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14
Q

Lithium renal SEs

A

Effects on tubular function (polyuria and thirst –> nephrogenic diabetes inspidus); effects on glomerulus (nephortic syndrome); tuberinterstitial nephritis (also called lithium induced nephropathy)

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15
Q

Which of the SEs of lithium is related to chronic use and is NOT reversible

A

Tuberinterstitial nephritis

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16
Q

Largely, lithium does what to the kidney?

A

Prevents urine concentration via vasopressin blocking

17
Q

Other lithium SEs (8)

A

Hypothyroidism, tremor, N/V, cardiac (depression of sinus node), benign leukocytosis, cognitive dulling/impaired memory, teratogencity, psoriasis/acne

18
Q

Lithium and pregnancy

A

Risk benefit conversation: can cause cardiac defect in fetus but may be better than manic pregnant woman

19
Q

What are signs of lithium toxicity (neuro and renal)

A

Neuro: Chreoathetosis, ataxia, dysarthria, aphasia, confusion; renal: irreversible damage

20
Q

What do we do to treat lithium toxicity

A

Stop drug, IV hydration, may need dialysis

21
Q

How to prescribe lithium; avoid?

A

Check lithium, renal, thyroid function every 6-12 months; avoid abrupt cessation (could cause mania)

22
Q

Valproate and BP disorder; mechanism? SEs?

A

Mania; enhances GABA, inhibits Na+; drug interactions (plasma protein binding, metabolized by p450); mostly GI, sedation, and pancreatitis/hepatoxicity, platelet problems

23
Q

Carbamazepine and BP disorder

A

Mania

24
Q

Lamotrigine and BP disorder

A

Maintenance

25
Q

Valproate is associated with what interesting syndrome? Not first-line for what group of people?

A

Polycystic ovarian syndrome (weight gain, acne, menstrual irregularities); young women (also because of teratogenicity = neural tube defect)

26
Q

Carbamazepine is a big…What does this cause? What else is weird?

A

Inducer of p450; induces hepatic metabolism of other drugs; INHIBITS its OWN metabolism (important for dosing)

27
Q

Carbamazepine SE are similar to..Also can cause…

A

Valproate; Stevens-Johnson, blood dyscresia

28
Q

Important drug interactions for Lamotrigine and a boxed warning

A

Valproate doubles serum levels while carbamazepine reduces levels; boxed warning = rashes (can be uncomplicated or SERIOUS)

29
Q

Lamotrigine is LESS likely to be associated with…

A

Weight gain/cognitive side effects