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M4 PSYCH > Mood Stabilisers (PSYCH DRUGS) > Flashcards

Mood Stabilisers (PSYCH DRUGS) Flashcards

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1
Q

Mood stabiliser indication

A

Acute mania in Bipolar disorder

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2
Q

Mood stabiliser examples

A

x4 - Lithium + 3 anticonvulsants
1. Lithium
2. Valproate
3. Carbamazepine
4. Lamotrigine

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3
Q

Lamotrigine indiciation

A
  1. Acute bipolar depression
  2. Depression prophylaxis
  3. Maintenance treatment in bipolar depression
    NOT in acute mania and mania prophylaxis
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4
Q

Most effective mood stabiliser

A

Lithium

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5
Q

Indications of lithium

A
  1. Gold standard for rx of acute mania (classic euphoric mania)
  2. Prophylaxis of bipolar disorder
  3. Anti suicidal properties in bipolar pt by reducing impulsivity
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6
Q

MOA of lithium

A

Target 2nd messenger systems (ie. at intracellular and molecular level) -> dampen excessive excitatory neurotransmission in mania

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7
Q

2nd messenger systems targeted by lithium

A
  1. Inositol monophosphatase
  2. Glycogen synthase kinase
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8
Q

Maintenance treatment serum lithium levels

A

0.6-0.8mmol/L

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9
Q

Lithium toxicity serum level

A

> 1.5mmol/L

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10
Q

Lithium toxicity symptoms

A

x3 groups
1. Gastro: vomiting, profuse diarrhea
2. Motor/Neuro: coarse tremor, ataxia, slurred speech, nystagmus
3. Mental/neuro: Drowsiness, confusion, seizures, coma

Acute toxicity - more gastro symptoms

Chronic toxicity - more neuro symptoms

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11
Q

Rating scale for severity of lithium toxicity

A

Amdisen rating scale

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12
Q

Side effects of lithium x6

A
  1. Tremor
  2. Renal effect (nephrogenic diabetes insipidus, chronic tubulointerstitial nephropathy - a/w long term use)
  3. Hypothyroidism
  4. Cardiac effect (heart block)
  5. Weight gain (Metabolic side effect)
  6. Teratogen - Lithium and pregnancy (Ebstein Anomaly)
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13
Q

Lithium monitoring (before starting and when using)

A

Pre-lithium:
1. ECG (Look out for SSS, heart block)
2. Renal panel, TFT

===
When starting:
1. Serum lithium, serum Cr, TFT every 6/12
*Measure serum lithium 12 hrs after last dose

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14
Q

Factors affecting serum Li concentration

A
  1. Dehydration - GI loss, heat, fever, fluid restriction (higher Li levels)
  2. Increased sodium intake (lower Li levels)
  3. Decreased sodium intake/sodium depletion -> reabsorption of Li along with Na (higher Li levels)
  4. Drug-induced (higher Li levels) - diuretics eg. Thiazide, NSAIDs, ACEi/ARB
  5. Drug drug interaction
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15
Q

Lithium patient education

A
  1. Advice adequate hydration (hot weather, diarrhea)
  2. Warn of drug interaction (diuretics, NSAIDs (analgeisa), ACEi, antacids (sodium bicarbonate)
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16
Q

Valproate MOA

A
  1. Inhibit sodium channel
  2. Increases GABA
17
Q

Indication of valproate

A

Mixed mania; can be given in loading dose for rapid control

18
Q

Side effects of valproate

A
  1. Nausea, sedation, weight gain, ataxia, thrombocytopenia
  2. Rare: fatal hepatotoxicity, pancreatitis, blood dyscrasis
19
Q

Valproate drug interactions

A
  1. Inhibits liver enzymes
  2. Interacts with drugs metabolised by liver
  3. Doubles lamotrigine levels by inhibiting lamotrigine glucoronidation (risk of SJS) *when using valproate, HALF dose of lamotrigine
20
Q

CI of valproate

A

Pregnancy! *caution use in women of childbearing age, rmb use contraception
- neural tube effect eg. Spina bifida

21
Q

F/U ix for valproate

A
  1. FBC - blood dyscrasis
  2. LFT - hepatotoxicity
22
Q

Pt education for valproate

A
  1. Warn of risk of hepatic & hematological rxn (educate S/S), report if occur
  2. Birth contraception
23
Q

Carbamazepine MOA

A

*same as valproate
1. Inhibit Na channel
2. Increases GABA

24
Q

Carbamazepine indication

A

Rapid cycling (>3 episodes a year)

25
Q

Side effect of carbamazepine

A
  1. Risk of agranulocytosis
  2. SJS (HLAB1502)
  3. Inducer of CYP450 -> Breakdown oral contraceptive -> contraceptive failure
26
Q

Lamotrigine MOA

A
  1. Inhibits Na channel

DOES NOT act on GABA (therefore not much effect in mania)

27
Q

Side effect of lamotrigine

A
  1. Serious rash (SJS/TEN) 1 in 1000

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