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Mental health > Mood stabilisers > Flashcards

Mood stabilisers Flashcards

1
Q

List the types of mood stabilisers

A

Antipsychotics
Anticonvulsant
Lithium

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2
Q

Name the indications for mood stabilisers

A

Treatment and prophylaxis of Bipolar affective disorder:

Hypomania, mania, depression, or mixed

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3
Q

Name the indications of Lithium

A

Treatment resistant depression (Tx and prophylaxis)
Bipolar affective disorder (gold standard Tx)
Mania (Tx and prophylaxis)
Aggressive or self-harming behaviour

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4
Q

What property of Lithium is especially useful in bipolar disorder and uni depression?

A

Lithium decreases suicidal ideation

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5
Q

List 3 side effects of Lithium

A 
NaV
GI disturbances
Fine tremor
Diabetes insipidus
Weight gain
Thyroid problems (Female 8:1)
*Teratogenic* - Ebstein's anomaly (cardiac)
Excreted in breast milk
Mild renal impairment ➔ risk of chronic renal failure
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6
Q

Describe the presentation of Lithium toxicity

A 
Seizures
Dysarthria
Reduced consciousness, coma
Ataxia
Coarse tremor
Acute kidney injury
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7
Q

What ECG changes are seen with Lithium?

A

Flattened T waves

Wide QRS

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8
Q

What drugs increase lithium plasma concentration?

A 
ACEi/ARBs
NSAIDs
SSRIs and other antidepressants
Diuretics (and dehydration)
Haloperidol and other antipsychotics
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9
Q

What drugs decrease lithium plasma concentration?

A

Antacids - neutralise stomach acid

Theophylline - COPD and Asthma

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10
Q

What monitoring is required when taking Lithium?

A 
Blood monitoring after each dose change
Weight (BMI)
eGFR
ECG
TFT (6 monthly)
U&E (6 monthly)
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11
Q

What should the serum level of Lithium be ideally?

A

Narrow therapeutic range (0.4 - 0.8/1.0)
Toxic above 1.0mmol/L
Symptomatic toxicity >2.5mmol/L

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12
Q

Describe the pharmacokinetics of Lithium

A

Renal reabsorption

*Important to maintain hydration

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13
Q

What can occur if Lithium is stopped abruptly?

A

Precipitation of mania

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14
Q

Name 3 anticonvulsants that work as mood stabilisers

A

Sodium valproate
Carbamazepine
Lamotrigine

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15
Q

Outline the mechanism of action of Sodium valproate

A

Voltage gated sodium channel blocker
Inhibits GABA breakdown
Inhibits GABA reuptake

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16
Q

What are the indications for Sodium valproate?

A

Bipolar disorder - mania
Prophylaxis for Bipolar disorder
Prophylaxis for migraines
Epilepsy

17
Q

Name 3 side effects of sodium valproate

A 
Tremor, sedation, headache
GI: anorexia, NaV, diarrhoea
Hyperammonaemia, thrombocytopenia
Hair loss
*Teratogenic: Neural tube defect

Fulminant hepatic failure (rare)

18
Q

What fulminant hepatic failure? Which anticonvulsant is it associated with?

A

Acute liver failure with rapid onset of encephalopathy in a patient with a previously health liver.

Associated with Sodium valproate

19
Q

What is a contraindication of sodium valproate?

A

FHx of hepatic dysfunction

20
Q

What monitoring is required whilst on sodium valproate?

A

FBC (6 monthly)
LFT (6 monthly)
Weight

Serum concentration if indicated (toxicity, compliance)

21
Q

What is the mechanism of action of Carbamazepine?

A

Voltage gated sodium channel blocker

22
Q

Name the indications for Carbamazepine

A

Bipolar disorder - when unresponsive to lithium
Tonic-clonic seizures
Adjunct in acute alcohol withdrawal
Trigeminal neuralgia

23
Q

Name 3 side effects of Carbamazepine

A 
Dizziness
Visual disturbances
Hyponatraemia, Oedema
GI disturbances: anorexia, nausea, constipation
Leukopenia (rare)

*Teratogenic - neural tube defect
Excreted in breast milk

24
Q

What monitoring is required whilst on Carbamazepine

A 
Serum levels (6 monthly)
FBC
LFT
U&E
TFTs (yearly)
25
Q

What is the effect of Carbamazepine on OCP?

A

Enzyme inducer ➔ reduced serum levels of OCP

26
Q

What is the mechanism of action of Lamotrigine?

A

Voltage gated sodium channel blocker

27
Q

What are the indications for Lamotrigine?

A

Epilepsy

Bipolar disorder - esp depression (maintenance Tx)

28
Q

Name 3 side effects of Lamotrigine

A

GI: nausea, vomiting, diarrhoea
Dizziness
Tremor
Ataxia

Stevens-Johnson syndrome: extensive mucocutaneous necrosis
Toxic epidermal necrolysis

Myelosuppression

29
Q

Which population is Lamotrigine most suitable for?

A

Women of childbearing age

Lamotrigine is not associated with increased risk of congenital malformation.

Mental health (27 decks)

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