Management of Mood Disorders Flashcards
What is the mode of action of lithium?
Blocks phosphatidylinositol pathway
Inhibits glycogen synthase kinase
Why must bloods be monitored when patient is on lithium?
lithium has a narrow therapeutic window
Can have very toxic side effects
List some of the toxic side effects of lithium
Vomiting Diarrhea Ataxia Course tremor Drowsiness Convulsions Coma Nephrotoxicity
List some of the common side effects of lithium:
Dry mouth Polydipsia and polyuria Hypothyroidism Weight gain Nephrogenic diabetes insipidus
What syndrome can develop as a side effect from Lamotrigine?
Stevens-Johnson Syndrome
When should you take lithium?
At night
Has sedatory side effects
What drugs interact with lithium?
ACE inhibitors
NSAIDs
ARBs
Diuretics - especially thiazides
What is lithium used to treat?
Bipolar disorder
Can be used as an add on in resistant depression
What investigations need to be done before prescribing lithium?
Us and Es
TFTs
ECG
When do check the lithium level in the blood?
12 hours after latest dose
What do you do if a patient on lithium develops hypothyroidism?
Add on levothyroxine
Tend not to stop lithium if possible
Describe the mechanism of action of sodium valproate:
Blocks voltage sensitive sodium channels and increases levels of GABA
What group of people do you avoid sodium valproate and why?
Women of childbearing age
Teratogenic
List some side effects of sodium valproate:
Sedation Tremor Dizziness GI upset Tiredness Weight gain
What is sodium valproate used to treat?
Epilepsy
Bipolar
Mania / Hypomania
What investigations should be done prior to starting sodium valproate?
Platelet count
LFTs
What is lamotrigine used to treat?
Epilepsy
Prophylaxis of bipolar depression
List some side effects of lamotrigine?
Rash (10%) GI upset Insomnia Dizziness Ataxia Tiredness
How is lamotrigine given
Titrated dose slowly over first 6 weeks to reduce risk of SJS / rash.
Then twice daily dosing
List some examples of atypical antipsychotics:
Olanzipine Risperidone quetiapine, amisulpride, paliperidone, clozapine
Which atypical antipsychotics are available as IM depots?
Olanzapine
Risperidone
List some side effects of antipsychotics:
Sedation / lethargy Weight gain Constipation & urinary retention EPSE QT prolongation Venous thromboembolism Neuroleptic malignant sydrome
Which anti-psychotic has different side effects and what are they?
Aripiprazole Insomnia GI upset Agitation Akathisia Orthostatic hypotension Headache Constipation
What investigations need to be done before prescribing an atypical anti-psychotic
ECG FBC Us and Es LFTs BP Weight Lipids Blood glucose
List some examples of typical antipsychotics:
Haloperidol Chlorpromazine Flupentixol Sulpiride Zuclopentixol
What is a typical antipsychotics main mechanism of action
Dopamine 2 receptor blockage
List some side effects of typical antipsychotics
EPSE Sedation Dizziness QT prolongation Neuroleptic malignant syndrome
What are used more, typical or atypical anti-psychotics
Atypical
What is the mechanism of action for atypical anti psychotics?
Dopamine antagonism and 5-HT antagonism
When can clozapine be used in the treatment of schizophrenia?
When the patient has not responded to adequate therapy with at least two different anti-psychotic medications
What can be offered alongside medication in the management of schizophrenia?
CBT
Can ECT be used in the treatment of schizophrenia?
No
What is a serious side effect of clozapine that must be monitored for?
Agranulocytosis
What medications lower the seizure threshold?
Anti-psychotics
Define torticollis:
“wry neck”
This is a dystonic condition defined by an abnormal, asymmetrical head or neck position
