Module 7 Unit C Mood Stabilizers and Antipsychotics Flashcards
What are the indications for the Lithium Mood Stabilizers (Eskalith, Lithobid, Lithostat, & Lithium carbonate)?
Bipolar I, maintenance
Bipolar I, acute manic/mixed
Schizoaffective disorder
What is the MOA of the Lithium Mood Stabilizers (Eskalith, Lithobid, Lithostat, & Lithium carbonate)?
Unknown and complex
Alters sodium transport across cell membranes in nerve and muscle cells
Alters metabolism of neurotransmitters, including catecholamines and serotonin
What D2D interactions are associated with the Lithium Mood Stabilizers (Eskalith, Lithobid, Lithostat, & Lithium carbonate)?
NSAIDs, diuretics (esp thiazides) Angiotensin-converting enzyme inhibitors, metronidazole (Flagyl) acetazolamide
What is the BBW associated with the Lithium Mood Stabilizers (Eskalith, Lithobid, Lithostat, & Lithium carbonate)? What are the symptoms?
Toxicity levels can occur at doses close to therapeutic levels.
Toxicity symptoms: Slurred speech, confusion, severe GI
Hepatotoxicity and pancreatitis
What monitoring is required with the Lithium Mood Stabilizers (Eskalith, Lithobid, Lithostat, & Lithium carbonate)?
Lithium levels must be monitored.
Kidney function.
What condition is often caused by long term use of Lithium?
Hypothyroidism is often caused by long-term use of lithium.
What is the indication for Carbamazepine (Tegretol)?
Bipolar Disorder
Seizures
What is the MOA of Carbamazepine (Tegretol)?
suppresses sodium influx
What D2D interactions are associated with Carbamazepine (Tegretol)
CYP450 3A4 inducers can lower plasma levels of carbamazepine
CYP450 3A4 inhibitors can increase plasma levels of carbamazepine
Carbamazepine can decrease plasma levels of hormonal contraceptives and adversely affect their efficacy
What BBW is associated with Carbamazepine (Tegretol)?
Serious dermatologic reactions/SJS and HLA-B*1502 Allele
Aplastic anemia/agranulocytosis
What are the indications for Valproic acid (Depakote)?
Partial seizures, Absence seizures, Bipolar disorder (acute manic), migraine headache prophylaxis
What is the MOA of Valproic acid (Depakote)?
Blocks voltage-sensitive sodium channels by an unknown mechanism
Increases brain concentrations of GABA by an unknown mechanism.
What is the BBW associated with Valproic acid (Depakote)?
Hepatotoxicity
Increased hepatotoxicity risk in mitochondrial disease
Fetal Risk
Pancreatitis
What are the indications for Lamotrigine (Lamictal)?
Bipolar I disorder, maintenance (helps in depressive phase)
Partial seizures
Seizures, primary generalized tonic-clonic
Migraine headache with aura prophylaxis
What is the MOA of Lamotrigine (Lamictal)?
Acts as a use-dependent blocker of voltage-sensitive sodium channels
Interacts with the open channel conformation of voltage-sensitive sodium channels
Interacts at a specific site of the alpha pore-forming subunit of voltage-sensitive sodium channels
Inhibits the release of glutamate and aspartate
What is the BBW associated with Lamotrigine (Lamictal)?
SJS/Serious Rash
What are the first-generation antipsychotics?
Haloperidol (Haldol)
Chlorpromazine
What are the indications for the first-gen antipsychotics (Haldol & chlorpromazine)?
Antipsychotic
Schizophrenia
What is the MOA of the first-gen antipsychotics (Haldol & chlorpromazine)?
Block receptors in and out of CNS such as dopamine, acetylcholine, histamine, and norepinephrine. They suppress symptoms of psychosis.
What monitoring should be done with the first-gen antipsychotics (Haldol & chlorpromazine)?
Blood monitoring – CBC, electrolytes, liver, and heart functions.
When are the first-gen antipsychotics (Haldol & chlorpromazine) contraindicated?
It is contraindicated in patients who are severely depressed or comatose or with Parkinson’s.
What D2D interactions are associated with the first-gen antipsychotics (Haldol & chlorpromazine) contraindicated?
anticholinergics, CNS depressants, Levodopa.
What are the Second Generation/Atypical Antipsychotics?
Clozapine (clozaril) Olanzapine (zyprexa) Ziprasidone (Geodon) Aripirazole (Abilify) Seroquel
What are the indications for the Second Generation/Atypical Antipsychotics (Clozapine, Olanzapine, Ziprasidone, Aripirazole)?
Schizophrenia
What is the MOA of the Second Generation/Atypical Antipsychotics (Clozapine, Olanzapine, Ziprasidone, Aripirazole)?
D2 antagonist and serotonin 2A antagonist
What adverse effects are seen with the Second Generation/Atypical Antipsychotics (Clozapine, Olanzapine, Ziprasidone, Aripirazole)?
Cardiometabolic risks: weight gain, obesity, dyslipidemia, diabetes, and accelerated cardiovascular disease.
What is the BBW associated with the 2nd gen Antipsychotics-Clozapine (Clozaril)?
Clozapine can cause life-threatening agranulocytosis and has been associated with myocarditis.
What drugs prolong QT?
FGA antipsych: Chlorpromazine, Haldol, Thioridazine
SSRIs: Citalopram (celexa), Escitalopram (Lexapro)
Common S/E with lithium
Nausea, fine-hand tremors, increased urination, and thirst.
Side effects of Tegretol
Common: Nausea, dizziness, headache, dry mouth, constipation, skin rash
Rare BBW: Agranulocytosis/aplastic anemia, Sevens-Johnson syndrome, allele
Monitoring with Tegretol
LFTs and CBC w/plt
Side effects of Depakote
Common: Nausea, diarrhea, abdominal cramps, sedation, tremor
Rare: Increased liver enzymes, Stevens-Johnson syndrome
BBW: Hepatoxicty, fetal risk, pancreatitis
Side effects Lamictal
Common: Dizziness, ataxia, somnolence, diplopia, nausea, headache, hepatotoxicity
BBW: Life-threatening rashes, including Stevens-Johnson syndrome
D2D Lamictal
Oral contraceptives are inducer, so will increase levels of lamictal.
Safety/SE of Haldol?
Common: extrapyramidal side effects, acute dystonia, parkinsonism, akathisia, tardive dyskinesia, sedation, hypotension
Prolonged QT
Hyperglycemia
BBW Haldol
Mortality in elderly
BBW 2nd generation/atypical antipsch
Suicide in adolescants.
Mortality in elderly
What is Neuroleptic Malignant Syndrome (NMS)
The most severe potential adverse effect of antipsychotics.
Syndrome: Muscular rigidity, hyperthermia, altered consciousness, and autonomic dysfunction
Associated with: antiemetics, lithium, anticholinergic, and serotonergic agents
