Mood stabilisers Flashcards
What are the three forms of valproate and their trade name?
Semi-sodium valproate (Depakote) (licensed for acute mania associated with bipolar disorder)
Valproic acid (Convulex) (licensed for epilepsy - unlicensed for bipolar)
Sodium valproate (Epilim) (licensed for epilepsy - unlicensed for bipolar)
What prominent side effects are associated with valproic acid?
GI - nausea, indigestion
Which 2 forms of valproate are more stable?
sodium valproate
semi-sodium valproate
WHy do you need a higher dose of sodium valproate compared to semi sodium valproate?
valproate semi-sodium 500 mg tablets contain 15.5% more valproic acid equivalent than sodium valproate 500 mg tablets.
What are serious side effects of valproate?
severe liver damage
pancreatitis
What are common side effects of valproate?
Liver injury*
Vomiting / diarrhoea**
Gingival hyperplasia
Memory impairment / confusional state
Somnolence
Weight gain
Anaemia / thrombocytopenia
Alopecia (with curly regrowth)
What are very common side effects of valproate?
nausea
tremor
What is there a transient rise in bloods of when starting valproate?
LFTs
What percentage of children exposed to valproate monotherapy during pregnancy suffer from congenital malformations? Is this risk dose dependent?
10%
Yes
What are the common congenital malformations seen with valproate use?
neural tube defects, facial dysmorphism, cleft lip and palate, craniostenosis (skull contractions), cardiac, renal and urogenital defects, limb defects (including bilateral aplasia of the radius).
What other effects does valproate have on child development?
Dose dependent relationship between valproate and developmental delay. 30-40% of children exposed in utero experience this.
3 fold increase of autism
What are the rules for starting valproate in women ?
<55 yrs - only initiate if 2 independent specialists have considered and documented there is no alternative.
Pregnancy prevention plan
What class of drugs is carbamazepine similar to?
TCAs
What is the mechanism of action of carbamazepine
binds to sodium channels increasing their refractory periodW
What are the contraindications for carbamazepine
History of bone marrow depression
Combination with MAOIs
What are very common side effects of carbamazepine?
Leucopenia
Ataxia, dizziness, somnolence
N+V
Urticaria
Fatigue
What are common side effects of carbamazepine?
Thrombocytopenia, eosinophilia
Oedema, fluid retention, weight increase, hyponatraemia, blood osmolarity decreased due to ADH like effect
Diplopia, blurred vision, headache
Dry mouth
