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Conditions: Psychiatry > Mood Stabilisers > Flashcards

Mood Stabilisers Flashcards

1
Q

Indication for mood stabilisers?

A

Bipolar
Cyclothymia
Schizoaffective disorder

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2
Q

What are the classes of mood stabilisers?

A

Lithium
Anticonvulsants
Antipsychotics

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3
Q

What is the indication for lithium use?

A

Mania

Depression

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4
Q

What are factors indicating good response to lithium?

A

Prior family remember who responds well
Classic pure mania
Mania followed by depression

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5
Q

What tests need to be done before prescribing lithium?

A

Baseline U+Es
TSH
Pregnancy test

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6
Q

What is lithium associated with causing in a foetus?

A

Ebsteins anomaly

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7
Q

What is ebsteins anomaly?

A

Tricuspid valve does not close properly

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8
Q

When is a steady state achieved in lithium therapy?

A

5 days

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9
Q

When are tests done after starting lithium therapy?

A

12 hours after last dose at 5 days

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10
Q

How often are tests once stable in lithium therapy?

A

3 monthly

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11
Q

What is tested at the 3 monthly checks?

A

TSH

Creatinine

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12
Q

What is the blood lithium level target?

A

Between 0.6 - 1.2

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13
Q

What are the SE of lithium?

A

GI

  • Reduced appetite
  • Diarrhoea
  • Nausea/vomiting

Thyroid problems

Reduced seizure threshold
Cognitive slowing
Tremor

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14
Q

What hormone does lithium antagonise?

A

ADH

- leads to polyuria and polydipsia

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15
Q

What may be seen on FBC in lithium?

A

Nonsignificant leukocytosis

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16
Q

What are signs of mild lithium toxicity and what blood lithium levels define it?

A

Blood lithium 1.5 - 2.0

  • Vomiting
  • Ataxia
  • Dizziness
  • Nystagmus
  • Slurring speech
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17
Q

What are signs of moderate lithium toxicity and what blood lithium levels define it?

A

Blood lithium 2.0 - 2.5

  • Vomiting
  • Anorexia
  • Blurred vision
  • Clonus
  • Convulsions
  • Syncope
18
Q

What are signs of severe lithium toxicity and what levels define it?

A

Blood lithium >2.5

  • Generalised seizures
  • Oliguria
  • Renal failure
19
Q

What anti-convulsants are good in psych?

A

Valproate
Carbamezapine
Lamotrigine

20
Q

When is valproate used?

A

Mania

21
Q

What predicts good response to valproate?

A

Rapid cycling
Substance issues
Anxiety disorders

22
Q

SE valproate?

A 
Thrombocytopenia and platelet dysfunction
Weight gain
Sedation
Tremor 
Risk of neural tube defect in pregnancy
23
Q

What is carbamezapine used for?

A

first line acute mania and prophylaxis

Good for rapid cyclers in bipolar disorder

24
Q

What bloods should be done before prescribing carbamezapine?

A

LFTs
FBC
ECG

25
Q

When should carbamezapine levels be re-tested and why?

A

At 1 month

There is a metabolic adjustment

26
Q

SE carbamezapine?

A

Rash very common

Nausea/vomiting

Sedation

AV conduction delat

Agranulocytosis

Urinary retention

27
Q

What type of anaemia may be caused by carbamezapine?

A

Aplastic

28
Q

What are side effects of lamotrigine?

A 
Sedation
Dizzines
Ataxia
Confusion
TEN/SJS
29
Q

What drugs may increase levels of lamotrigine?

A

Sertraline

Valproate

30
Q

Antipsychotic for manic, mixed and maintainance bipolar?

A

Aripiprazole

Olanzapine

31
Q

Antipsychotic for manic and mixed but not for mainainence of bipolar?

A

Risperidone

32
Q

Antipsychotic for manic and mainanence but not mixed?

A

Quitiapine

33
Q

Antidepressent for manic, mainainance and depressive bipolar?

A

Quitiapine XR

34
Q

How do typical antipsychotics work?

A

D2 dopamine receptor antagonists

35
Q

What is the big SE of typicals?

A

Extrapyramidal side effects

36
Q

What are extrapyramidal se?

A

Tardive dyskinesia
Restlessness
Akithisia

37
Q

What are examples of typicals?

A

Haloperidol

Fluphenazine

38
Q

What are other types of typicals?

A

Low potency typicals

39
Q

How do low potency typicals work?

A

Have a lower D2 affinity but can interact with other non-dopaminergic receptors

40
Q

What are the SE of low potency atypicals?

A

Cardiotoxicity
Anticholinergic
- Sedation
- Hypotension

41
Q

How do atypical antipsychotics work?

A

Serotonin-dopamine 2 antagonists

42
Q

What pathways are said to be worked on by atypical antipsychotics?

A

The 4 major dopamine pathways of the brain

Conditions: Psychiatry (17 decks)

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