Mood stabilisers Flashcards
List the types of mood stabilisers
Antipsychotics
Anticonvulsant
Lithium
Name the indications for mood stabilisers
Treatment and prophylaxis of Bipolar affective disorder:
Hypomania, mania, depression, or mixed
Name the indications of Lithium
Treatment resistant depression (Tx and prophylaxis)
Bipolar affective disorder (gold standard Tx)
Mania (Tx and prophylaxis)
Aggressive or self-harming behaviour
What property of Lithium is especially useful in bipolar disorder and uni depression?
Lithium decreases suicidal ideation
List 3 side effects of Lithium
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
Describe the presentation of Lithium toxicity
Seizures Dysarthria Reduced consciousness, coma Ataxia Coarse tremor Acute kidney injury
What ECG changes are seen with Lithium?
Flattened T waves
Wide QRS
What drugs increase lithium plasma concentration?
ACEi/ARBs NSAIDs SSRIs and other antidepressants Diuretics (and dehydration) Haloperidol and other antipsychotics
What drugs decrease lithium plasma concentration?
Antacids - neutralise stomach acid
Theophylline - COPD and Asthma
What monitoring is required when taking Lithium?
Blood monitoring after each dose change Weight (BMI) eGFR ECG TFT (6 monthly) U&E (6 monthly)
What should the serum level of Lithium be ideally?
Narrow therapeutic range (0.4 - 0.8/1.0)
Toxic above 1.0mmol/L
Symptomatic toxicity >2.5mmol/L
Describe the pharmacokinetics of Lithium
Renal reabsorption
*Important to maintain hydration
What can occur if Lithium is stopped abruptly?
Precipitation of mania
Name 3 anticonvulsants that work as mood stabilisers
Sodium valproate
Carbamazepine
Lamotrigine
Outline the mechanism of action of Sodium valproate
Voltage gated sodium channel blocker
Inhibits GABA breakdown
Inhibits GABA reuptake
What are the indications for Sodium valproate?
Bipolar disorder - mania
Prophylaxis for Bipolar disorder
Prophylaxis for migraines
Epilepsy
Name 3 side effects of sodium valproate
Tremor, sedation, headache GI: anorexia, NaV, diarrhoea Hyperammonaemia, thrombocytopenia Hair loss *Teratogenic: Neural tube defect
Fulminant hepatic failure (rare)
What fulminant hepatic failure? Which anticonvulsant is it associated with?
Acute liver failure with rapid onset of encephalopathy in a patient with a previously health liver.
Associated with Sodium valproate
What is a contraindication of sodium valproate?
FHx of hepatic dysfunction
What monitoring is required whilst on sodium valproate?
FBC (6 monthly)
LFT (6 monthly)
Weight
Serum concentration if indicated (toxicity, compliance)
What is the mechanism of action of Carbamazepine?
Voltage gated sodium channel blocker
Name the indications for Carbamazepine
Bipolar disorder - when unresponsive to lithium
Tonic-clonic seizures
Adjunct in acute alcohol withdrawal
Trigeminal neuralgia
Name 3 side effects of Carbamazepine
Dizziness Visual disturbances Hyponatraemia, Oedema GI disturbances: anorexia, nausea, constipation Leukopenia (rare)
*Teratogenic - neural tube defect
Excreted in breast milk
What monitoring is required whilst on Carbamazepine
Serum levels (6 monthly) FBC LFT U&E TFTs (yearly)
What is the effect of Carbamazepine on OCP?
Enzyme inducer ➔ reduced serum levels of OCP
What is the mechanism of action of Lamotrigine?
Voltage gated sodium channel blocker
What are the indications for Lamotrigine?
Epilepsy
Bipolar disorder - esp depression (maintenance Tx)
Name 3 side effects of Lamotrigine
GI: nausea, vomiting, diarrhoea
Dizziness
Tremor
Ataxia
Stevens-Johnson syndrome: extensive mucocutaneous necrosis
Toxic epidermal necrolysis
Myelosuppression
Which population is Lamotrigine most suitable for?
Women of childbearing age
Lamotrigine is not associated with increased risk of congenital malformation.
