Mood Stabilisers Flashcards
Give examples of mood stabilisers
Lithium
Sodium valproate
Carbamazepine
Lamotrigine
What is the therapeutic range for lithium
0.6-0.8 (1)
What are the side effects of lithium
Lethargy
Insipidus diabetes, nephrogenic
Tremor (fine)
Hypothyroidism
Insides → N&V
Urine increased
Metallic taste in mouth
+ loss of eyebrow hair, weight gain, nephrotoxic
What are the features of lithium toxicity
> 1.2 mmol/L, may be triggered by dehydration, NSAIDS, ACEi, diuretics, celecoxib use
Coarse tremor (fine in therapeutic levels)
Hyperreflexia
Nystagmus
CNS: ataxia, confusion, seizures
GI: N&V, renal failure
Polyuria, polydipsia
How is lithium monitored
Must do before starting: ECG, BMI, TFTs, FBC, U&Es, calcium
Monitored every week until stable level (5 weeks), then every 3 months
U&Es and TFTs every 6 months
Must do BP and ECG before and after each dose change
Monitor lithium levels 12h after changing
What are the risks of lithium use
Pregnancy → ebstein’s anomaly
Discontinuing suddenly → relapse
Benign leukoCYTOSIS
What are the side effects of sodium valproate
N&V, diarrhoea
Liver failure
Thrombocytopenia
Hair loss
Weight gain
What is the effect of valproate on pregnancy
Increases risk of spina bifida
Cannot be prescribed to women of child-bearing age unless a pregnancy prevention programme is in place
What are the side effects of carbamazepine
Skin rash
leucopenia
Dizziness
Ataxia
Drowsiness, fatigue,
N&V
Oedema
Weight gain
Hyponatraemia
What are the considerations for carbamazepine
Enzyme inducer → must consider contraception
Pregnancy → spina bifidia
What are the side effects of lamotrigine
Severe skin rash (SJS)
Headache, fatigue
Nausea, dizziness
Insomnia
Arthralgia, back pain
What is the treatment for lithium toxicity
mild-moderate toxicity may respond to volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity
