Mood Stabilisers

Question 1

when are mood stabilisers used

Answer 1

bipolar disorder, cyclothymia (depression+hypomania), schizophrenia

Question 2

what are the main groups of mood stabilisers

Answer 2

Lithium
Anticonvulsants
Antipsychotics (see other flashcards)
Anixiolytics (see other flashcards)

Question 3

what are some benefits of lithium

Answer 3

has decreased suicide rates compared to other drugs

can be used as long term prophylaxis for depression with mania (works better if the mania came before the depression)

Question 4

what should be done before lithium is used

Answer 4

check baseline U&Es
check TSH levels
pregnancy test

Question 5

how is the use of lithium monitored

Answer 5

should reach a steady state after 5 days

• check levels 12 hours after last dose
• check levels every three months
• check TSH and creatinine every 6 months

goal is a blood level of 0.6-1.2

Question 6

what are the side effects of lithium

Answer 6

GI distress
thyroid problems
leukocytosis
polyuria/polydipsia
hair loss/acne
cognitive slowing
intention tremor

Question 7

what are the levels of lithium toxicity and their side effects

Answer 7

mild - 1.5-2.0
- N/V, diarrhoea, ataxia, dizziness, slurred speech, nystagmus

moderte - 2.0-2.5
- N/V, anorexia, blurred vision, clonic limb movemebts, convulsions, delirium, syncope

severe - >2.5
- generalised convulsions, oligouria, renal failure

Question 8

what are the three main anticonvulsants

Answer 8

Valproic acid
Carbamazepine
(Lamotrigine)

Question 9

what are the pros of using valproic acid

Answer 9

good for mania prophylaxis (less for depression)
better tolerated than lithium
good for combined substance issues/anxiety

Question 10

what must be checked before valproic acid is used

Answer 10

check baseline LFTs
pregnancy test
FBC
start folic acid supplement in women

Question 11

how is the use of valproic acid monitored

Answer 11

steady state after 4-5 days

• check levels 12 hours after last dose as well as FBC and LFTS
• levels should be 50-125

Question 12

what are the side effects of valproic acid

Answer 12

thrombocytopenia, platelet dysfunction
N/V
weight gain
sedation, tremor
increased risk of neural tube defect
increased hair loss

Question 13

what are the pros of using carbamazepine

Answer 13

its a first line agent for acute mania
good for mani prophylaxis
good for rapid cycler or comorbid conditions

Question 14

what must be checked before carbamazepine is used

Answer 14

baseline LFTs, FBC, ECG

Question 15

how is the use of carbamazepine monitored

Answer 15

steady state after 5 days

• 12 hours after last dose to check FBC, LFTs
• levels should be 4-12 mcg/ml

Question 16

what are the side effects of carbamazepine

Answer 16

rash
N/V
diarrhoea
sedation, dizziness, ataxia, confusion
AV conduction delay
aplastic anaemia
water retention
drug-drug reactions

Question 17

why is it important to know about drug to drug reactions with carbamazepine

Answer 17

it increases its own metabolism and that of many other drugs

Question 18

what are the side effects of lamotrigine

Answer 18

N/V
seation, dizziness, ataxia, confusion
TEN, steven johnsons syndrome**

**discontinue if any rash occurs