Mood Stabiliser

Question 1

List the different types of mood stabilisers

Answer 1

Lithium
Anticonvulsants:
-sodium valproate, carbamezapine, lamotrogine
Antipsychotics
-haloperidol, olanzepine

Question 2

Lithium: MOA, SE, CI

Answer 2

MOA:
-increase GABA and serotonin activity
SE: WTPAGE
Weight gain
Tremor (fine), Thyroid dysfunction
Polydipsia, polyuria
Ataxia, weakness, lethargic, aggravation of acne and psoriasis
GI: nausea and diarrhoea and impaired hepatic function
EPSE
CI
Cardiovascular disease
Renal impairment
Pregnancy
CNS disorder
Mystagia gravis

Question 3

Lithium: Therapeutic Range and monitoring, test and pregnancy

Answer 3

TI: narrow, meaning that that there is a narrow window between the effective therapeutic dose and the dose that cause adverse effects. Therapeutic range 0.8-1 m 0.6 to 0.8
Require close monitoring
Monitoring:
1.Lithium levels every 5-7 days until stable, than every month for 3month than 3 monthly for 6-12 months than 6 monthly while taking this drug
2. Renal and thyroid function every 6-12 months and prior initiation
3. Weight: lipogram and serum hgt
Test:
FBC
GFR
Thyroid
BHCG
UE
Pregnancy
Always rule-out pregnancy and give contraceptives while taking lithium make sure that the thyroid is okay

Question 4

Lithium toxicity and management

Answer 4

If >1,5
GI: nausea, vomiting, diarrhoea and anorexia
CNS:TH(E) DAM
tremor(course), hyperreflexia
drowsiness, apraxia, muscle weakness and twitchiness
>2
Above plus
CNS: DISC
increased disorientation, seizures, coma, death

STOP lithium and normal saline and bicarbonate soda. PEG solution

Question 5

Lithium: drug-drug interactions

Answer 5

Antipsychotics
SSRI
ACE-inhibitor, ARBS
Diuretics
NSAIDs
Antithyroid
Caffeine

Question 6

List the mood stabilisers anticonvulsants

Answer 6

Sodium Valproate
Carbamezapine
Lamotrigine

Question 7

Anticonvulsants (SV): MOA, SE, CI, MONITOR

Answer 7

Sodium Valproate
MOA:
Blocks the voltage-gated sodium channels and enhance GABA activity
SE:
PCO
Hair loss
Hepatotoxic
Haemological abnormalities
Lethargy
Oedema-ankle
Weight gain
Sedation and tremor
CI
Pregnancy and pregnancy
Liver disease
MONITOR
LFTS 2 weeks after and 6 monthly with FBC and Renal

Question 8

Anticonvulsants (C):MOA, SE, CI, MONITORING

Answer 8

Carbamezapine
MOA: preferentially bind to voltage-gated channels resulting in the prevention of repetitive and sustained firing of AP
SE: S2HAV’D
Sedation
Skin rashes: erythematous rash SJS
SIADH
Haematological abnormalities
Anorexia, Nausea and vomiting
Vertigo
Dry mouth, drowsiness, dizziness
CI ABBP
AV block
Bone marrow suppression
Blood disorder
Pregnancy and Breast feeding
MONITORING
UE
LFT
FBC
Every 6 months

Question 9

Anticonvulsants (L): MOA, SE, CI

Answer 9

MOA:
Inhibit Na channel and glutamate release
SE:
Sedation/ skin reactions
Nausea and vomiting
Insomnia
Dizziness
CI:Impaired hepatic and renal function