Mood stabilisers Flashcards
What is the indications and contraindications for lithium
o 1st line for bipolar disorder
o Prophylaxis of manic or depressive episodes
o Acute mania
o Recurrent depression in bipolar disorder
o Treatment resistant depression to augment antidepressants
contra
o Pregnancy (1st trimester, teratogenic – Ebstein anomaly) + breastfeeding
o Renal failure (eGFR <30)
What are the monitoring requirements for lithium, what is the dose range, target conc and checking levels
Prior to initiating treatment check:
o TFTs
o U+Es (Serum calcium, Renal function)
o ECG
o hCG + Make sure women are on contraception
Dose is 400-1200mg. Therapeutic conc
0.4–1 mmol/L
Check levels 12 hours after dose
o Renally excreted – increased conc in dehydration / renal disease
o Check levels weekly after initiation and after each dose change until concentrations are stable, then every
3 months
o Need to taper dose
Then TFTs (for hypo) and U+Es every 6 months once on stable regime
What are the common drug interactions with lithium
o Thiazide diuretics
o NSAIDs
o ACEi
o Tetracyclines
o Cyclosporine
What are the adverse effects of lithium - GI, skin, muscle, Neuro, endocrine, haem
GI upset – N&V, diarrhoea, weight gain, anorexia,
o Fine tremor (symmetric) – treated with Propanolol
o Extrapyramidal adverse effects
o Nephrogenic diabetes insipidus - Polyuria +polydipsia
o Skin – acne, worsens psoriasis, hair thinning
o Muscle weakness
o ECG changes – QT prolongation, sinus node dysfunction (brady)
o Hypothyroidism / hyperthyroidism /
Hyperparathyroidism
o Leucocytosis
o Serotonin syndrome
What are the symptoms of lithium toxicity and treatment
o Lithium toxicity = serum concentration >1.5mmol/L
- GI: N&V, diarrhoea
- Neuro: Altered mental status, confusion, delirium, somnolence, encephalopathy,
tremor, myoclonic jerks, fasciculations, hyper-reflexia, ataxia, nystagmus,
slurred speech, seizures, coma
- Acute renal failure – polydipsia, polyuria
- Treatment: stop lithium + fluids + haemodialysis
MoA of sodium valproate, indications and contraindicaitons
o Inhibits Na+ channels
o Enhances GABA
Indications
o Bipolar disorder- acute mania
Contrindications
-Pregnancy -teratogenic NTD , child bearing age male and female and breastfeeding
- liver dysfunction
- mitochondrial disease
monitoring requirements for sodium valproate
Pretreatment
- LFTS, prothrombin time, serum fibrinogen and albumin
- FBC, Coags, bleeding time
- plasma HcG
ongoing
Liver function/ clinical signs of liver failure until 6 months after maintenence
- FBC every 3 months until 1 year
- Body weight
- contraception
Adverse effects of sodium valproate
o GI upset – N&V, diarrhoea,
abdo pain, weight gain,
deranged LFTs
o Dizziness
o Weakness
o Tremor, ataxia
o Sedation, somnolence
o Alopecia
o Rare: pancreatitis,
Hepatotoxicity - malaise,
anorexia, vomiting, abdo pain,
drowsiness, jaundice, weakness,
facial oedema
o Thrombocytopenia,
agranulocytosis
dosing with sodium valproate
o usually 1-2g daily in 3 divided dose in maintenance start with 600mg
o titrated on effect and tolerability routine monitoring not recommended but if need to check then 2-4 days after treatment change collecting sample before next dose is due
o Need to taper dose if stopping
Carbemazpine - moa, indications and contraindications
Na channel blocker - depressant effect on D2 and Noradrenaline turnover
Indicstion
acute mania and maintenance treatment of bipolar affective disorders;
Contraindication
AV conduction abnormalities (unless paced); history of bone marrow depression; use of monoamine oxidase inhibitors (MAOI) within 14 days; acute porphyrias
monitoring requirements and adverse effects of carbamazepine
Monitor full blood counts, electrolytes, creatinine and urea, and liver function annually.
Monitor for the emergence or worsening of depression, suicidal thoughts or behaviour, and any unusual changes in mood or behaviour,
Adverse effects
GI upset – N&V, diarrhoea/constipation, dry mouth, pancreatitis
o Blood disorders - eosinophilia, leucopenia, thrombocytopenia
- Dermatitis urticaria ; severe cutaneous reactions
- Hepatototoxicity - metabolism impaired in advanced liver disease
o Diplopia, blurred vision
o Vertigo, nystagmus, ataxia
o Fatigue
