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YR5 Psychiatry > Mood Stabilisers > Flashcards

Mood Stabilisers Flashcards

1
Q

What monitoring is required for Lithium?

A

After STARTING + after each dose CHANGE until concentrations are stable: lithium levels weekly

Once established: lithium levels every 3 months

TFTs, U+Es, eGFR, Calcium + BMI : every 6 months

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2
Q

What is the mechanism of action of Lithium?

A

interferes with inositol triphosphate formation
interferes with cAMP formation

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3
Q

What is the therapeutic range of Lithium?

A

0.4-1.0 mmol/L

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4
Q

How is Lithium excreted?

A

Long plasma half-life
Excreted primarily by the kidneys.

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5
Q

When should Lithium levels be taken?

A

12h post dose

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6
Q

List 7 adverse effects of Lithium

A

N+V
Diarrhoea
Fine tremor
Weight gain
Thyroid enlargement, may lead to HYPOthyroidism
Leucocytosis
Hyperparathyroidism + resultant hypercalcaemia

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7
Q

What 2 adverse cardiovascular effects can Lithium have?

A

T wave flattening/ inversion on ECG
Idiopathic intracranial hypertension

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8
Q

What adverse effect can Lithium have on the kidneys?

A

Nephrotoxicity:
Polyuria + polydipsia secondary to nephrogenic diabetes insipidus

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9
Q

Give 3 precipitants of Lithium toxicity

A

Dehydration
Drugs
Renal failure

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10
Q

List 4 drugs that can precipitate Lithium toxicity

A

Diuretics- esp Thiazides
ACEi/ ARBs
NSAIDs
Metronidazole

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11
Q

List 6 features of Lithium Toxicity

A

Coarse tremor (a fine tremor is seen in therapeutic levels)
Hyperreflexia
Acute confusion
Polyuria
Seizure
Coma

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12
Q

What is the management of mild-moderate Lithium Toxicity?

A

Volume resus with normal saline

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13
Q

What is the management for severe Lithium toxicity?

A

Haemodialysis

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14
Q

What may be used in Lithium toxicity, but has limited evidence to support its use?

A

Sodium bicarbonate
Increases alkalinity of urine- promotes lithium excretion

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15
Q

At what concentrations does Lithium toxicity generally occur?

A

> 1.5 mmol/L

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16
Q

If Lithium is ineffective/ SE cannot be tolerated, which drug can be used?

A

Valproate

17
Q

List 4 gastric side effects of Valproate

A

Nausea
Increased appetite + weight gain
Pancreatitis
Hepatotoxicity

18
Q

Give 2 neuropathy side effects of Valproate

A

Ataxia
Tremor

19
Q

Give 4 systemic side effects of Valproate

A

Alopecia: curly regrowth
Thrombocytopenia
Peripheral oedema
Hyponatraemia

20
Q

What is the teratogenic effect of Lithium in pregnancy?

A

Ebstein’s anomaly
Tricuspid valve defect- atrialisation of RV

21
Q

What is the teratogenic effect of valproate or carbamazepine in pregnancy?

A

Neural tube defects

22
Q

What is the monitoring regime for valproate?

A

No monitoring required

YR5 Psychiatry (33 decks)

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