Mood stabilisers Flashcards
What is first line prophylaxis in BPAD?
Lithium
what is the MOA of lithium?
Decreased activity of sodium dependient intracellular secondary messenger systems and modulation of dopamine and serotonin NT pathways.
Side effects of lithium?
GI disturbance
Leucocytosis Impaired renal function Tremor Teratogenic Thirst Hypothyroidism Hair loss Increased weight and fluid retention Urine - polyuria Metallic taste
What occurs in lithium toxicity?
Tremor (coarse) Oliguric renal failure AtaXia Increased reflexes Convulsions, coma, reduced Consciousness
What are contraindications to lithium?
Renal failure
Pregnancy
Breast feeding
Untreated hypothyroidism and Addison’s
Caution:
QT prolongation
Epilepsy - reduces the seizure threshold
Diuretic therapy
Before starting, which investigations?
U&E and eGFR - renal excretion and nephrotoxic
TFT - CI in untreated hypothyroidism
Pregnancy status - teratogenic
ECG - QT prolongation
What monitoring for lithium? How long must it be given for?
12 hours after first dose, weekly until therapeutic level stable for 4 weeks
Check every 3 months
U&E every 6 months - signs of renal failure
TFTs every 12 months - signs of hypothyroidism
calcium
creatinine
18 months
What should you advise patients on lithium?
Signs of hypothyroidism Contraceptive advice Potential toxicity Regular fluid intake Compliance Dangers of dieting Avoid NSAIDs
How does lithium toxicity present? How is it exacerbated? How is it managed?
Tremor (coarse) Oliguric renal failure, AtaXia, Increased reflexes, Convulsions, Coma, Consciousness reduced
Dehydration
Drugs (NSAIDs, ACEi)
Diuretics
Depletion of sodium
Stop lithium
IV NaCl to stimulate osmotic diuresis
Renal dialysis if severe
Indications, MOA, SE, CI, Monitoring for sodium valproate?
Second line in acute mania after lithium and atypical antipsychotic
Rapid cycling BPAD
Enhances GABA transmission by reducing catabolism
Sodium channel blocker, calcium channelblocker
GI disturbances Weight gain Aggression LFTs raised Platelets low - thrombocytopoenia Oedema (peripheral) ataxia Tremor/teratogenix Emesis
Avoid in pregnancy
Hepatic dysfucntion
FBC - check platelets
Pregnancy test
Weight/BMI
LFTs/PT
Indications, MOA, SE, CI, Monitoring of Carbamazepine?
Prophylaxis of BPAD unresponsive to lithium, alcohol withdrawal
VGSC blocker
GI disturbance Dermatitis Dizziness Hyponatraemia Thrombocytopenia, leucopenia
CI in cardiac disease, blooddisorders, AV block, pregnancy
Interacts with COCP - enzyme inducer
ECC
LFT U&E
Indications, MOA, Side effects, contraindications, monitoring of Lamotrigine
BPAD - less teratogenic
Sodium channel blocker - stabilise the neuronal membrane
GI disturbance Rash Headache Hypersensitivity TRemor
Interacts with carbemazepine
LFTs FBC
U&E
