Mood Stabilizers Flashcards
Brand name for lithium?
Lithobid
Generic: Lithium Carboante and Lithium Citrate
It is thought that Bipolar disorder is due to [over or under?] activation of the excitatory neuronal system in mania and over activation of the inhibitory neural system in ________. Lithium seems to dampen these neural systems
over activation; depression
It is thought that Bipolar disorder is due to over activation of the excitatory neuronal system in mania and over activation of the inhibitory neural system in depression. Lithium seems to dampen these neural systems
Lithium dosage varies, depending on the pt’s _____, ______, & _______?
Size; age; kidney function
Dosages may vary from 900mg to 1800mg/day in 3 or 4 divided doses depending on the patient’s size, age, and kidney function
Lithium: Start at 300mg PO BID or TID and increasing by 300mg/day every __ to __ days until manic symptoms abate and blood levels are between ____ and ______ mEq/L
3 to 5 days; 0.6 to 1.2 mEq/L
Lithium: Start at 300mg PO BID or TID and increasing by 300mg/day every 3-5 days (i.e., every few days) until manic symptoms abate and blood levels are between 0.6 and 1.2 mEq/L (i.e., the therapeutic window)
Lithium dosages may vary from _____ mg to _____ mg/day in ____ or ______ divided doses depending on the patient’s size, age, and kidney function
900mg to 1800mg/day in 3 or 4 divided doses
Lithium dosages may vary from 900mg to 1800mg/day in 3 or 4 divided doses depending on the patient’s size, age, and kidney function
Therapeutic window for lithium?
0.6 to 1.2 mEq/L
Toxic side effects can occur when lithium level exceeds _____ mEq/L
1.5 mEq/L
toxic side effects can occur when the lithium level exceeds 1.5 mEq/L
Regarding lithium side effects- what is one way to avoid upset stomach?
take meds with food
lithium- avoiding upset stomach
Tinnitus is a [early/higher/very] toxicity level for lithium?
higher
Tinnitus is a higher toxicity level for lithium
Ataxia is a [early/higher/very] toxicity level for lithium?
higher
ataxia is a higher toxicity level for lithium
ataxia - the loss of full control of bodily movements
drowsiness, diarrhea, nausea, vomiting, dizziness, muscle weakness, and impaired coordination are [early/higher/very] toxicity level for lithium?
early
Early symptoms of lithium toxicity: drowsiness, diarrhea, nausea, vomiting, dizziness, muscle weakness, and impaired coordination
danger of death resulting from seizures, acute renal failure, cardiac arrhythmias, low blood pressure, cardiovascular collapse, and delirium are [early/higher/very] toxicity level for lithium?
very toxic
Very toxic levels: there is danger of death resulting from seizures, acute renal failure, cardiac arrhythmias, low blood pressure, cardiovascular collapse, and delirium
Lithium is excreted through ____?
kidneys
Lithium is excreted through KIDNEYS
If someone is dehydrated, on a low salt diet or on some “water pills” the kidneys will ________ lithium more intensely and this will result in [higher or lower] lithium levels
reabsorb; higher
If someone is dehydrated, on a low salt diet or on some “water pills” the kidneys will REABSORB lithium more intensely and this will result in HIGHER lithium levels
Long term use of lithium may affect thyroid glands and cause [hypo or hyper] thyroidism?
hypO
Long term use of lithium may affect thyroid glands and cause hypothyroidism (underactive thyroid; doesn’t produce enough crucial hormones)
Use of lithium in 1st trimester has been associated with the _________ anomaly
Ebstein
Lithium Use in the first trimester of pregnancy is associated with birth defects, mostly cardiovascular
EBSTEIN ANOMALY- a rare heart defect in which the tricuspid valve — the valve between the upper right chamber (right atrium) and the lower right chamber (right ventricle) of the heart — isn’t formed properly
Monitor for neurotoxicity and movement disorders (EPS) with ________ (esp ______ ) when used in conjunction with Lithium
antipsychotics; Haldol
Monitor for neurotoxicity and movement disorders (EPS) with antipsychotics (esp Haldol) when used in conjunction with lithium
antipsychotics + lithium = no good! need to monitor!
only these 2 anticonvulsants have been consistently been effective for BD:
only Valproate and Carbamazepine have proven to be consistent reg efficacy in treating BD
Brand names for valproate:
Depakene, Depakote, Depacon
brand name for valproate
vd vd voodoo vicii
How long does it take for valproate & carbamazepine to work?
How long does it take for valproate & carbamazepine to work?
For acute mania, effects should occur within a few days depending on the formulation of the drug but takes several weeks to months to optimize an effect on mood stabilization
Spina bifida has been reported in 1st trimester use of which BD meds?
valproate / Depakote + carbamazepine / Tegetrol
Spina Bifida and abnormal brain development have been reported in the children of women taking these during the first trimester of pregnancy
v & c meds have spina bifida
valproate is metabolized in the ______
liver
valproate is metabolized in the liver
valproate can affect the metabolism of other meds; it has been associated with increased blood levels of ________ - warfarin (Coumadin), carbamazepine, phenobarbital, tolbutamide, ethosuximide, and zidovudine
TCAs
valproate can affect the metabolism of other meds; it has been associated with increased blood levels of ________- warfarin (Coumadin), carbamazepine, phenobarbital, tolbutamide, ethosuximide, and zidovudine.
Carbamazepine, rifampin, HIV medications and some antibiotics may [increase or decrease] valproate levels which can [increase or decrease] therapeutic effectiveness of valproate considerably
decrease; decrease
Carbamazepine, rifampin, HIV medications and some antibiotics may decrease valproate levels which can decrease therapeutic effectiveness of valproate considerably
The interaction of ________ and valproate is a concern. Valproate can double the blood levels of X drug, and serious skin reactions have been reported with concomitant X and valproate administration
lamotrigine (Lamictal)
The interaction of lamotrigine (Lamictal) and valproate is a concern. Valproate can double the blood levels of lamotrigine, and serious skin reactions have been reported with concomitant lamotrigine and valproate administration
*Va & La do not mix!!!!
brand name for carbamazepine?
Tegretol, Carbatrol, Equetro
brand name for carbamazepine
for carbamazepine, blood levels need to be monitored weekly for first ___ to ___ weeks?
Levels can drop suddenly in first few weeks bc carbamazepine enhances its own metabolism
6 to 8 weeks
for carbamazepine, blood levels need to be monitored weekly for first 6-8 weeks (i.e., first 2 months)
Levels can drop suddenly in first few weeks bc carbamazepine enhances its own metabolism; so check over the first 2 months for carb
for this med, ppl with ancestry across broad areas of Asia with the HLA-B*1502 allele should not be treated with this drug
carbamazepine
for this med, ppl with ancestry across broad areas of Asia with the HLA-B*1502 allele should not be treated with this drug
no carbs for asians
for carbamazepine, along with liver, kidney, & thyroid tests, this should also be examined prior to starting
white blood cell count - WBC
Before the carbamazepine is started, white blood cell count (WBC), liver, kidney and thyroid function tests should be conducted
c needs WBC count
c needs WBCc
cWBCc
Grapefruit juice increases metabolism .. leading to adverse effects of which med?
carbamazepine
carbs & grapefruit don’t mix
Early symptoms of toxicity of ________ include neuromuscular disturbances such as jerky eye movements (nystagmus), muscle jerks (myoclonus), increased reflex reactions (hyperreflexia) and severe nausea and vomiting
carbamazepine
Early symptoms of toxicity of this include neuromuscular disturbances such as jerky eye movements (nystagmus), muscle jerks (myoclonus), increased reflex reactions (hyperreflexia) and severe nausea and vomiting
carbs lead to jerky movement sxs
________ is metabolized in the kidney; while these other 3 are metabolized in the liver?
lithium vs. valproate, carbamazepine, lamotrigine
lithium is metabolized in the kidney; while valproate carbamazepine, lamotrigine are metabolized in the liver
lithium is metabolized in the _______; while valproate and carbamazepine are metabolized in the ________
kidney vs. liver
lithium is metabolized in the kidney; while valproate and carbamazepine are metabolized in the liver
brand name for lamotrigine?
Lamictal
for lamotrigine/Lamictal- Start with 25mg for __ weeks before increasing to 50mg by week __ and 100mg/day by week __
2 weeks; week 3, week 5
for lamotrigine/Lamictal- Start with 25mg for 2 weeks before increasing to 50mg by week 3 and 100mg/day by week 5
L meds are 2, 3, 5
25, 50, 100mg
for lamotrigine/Lamictal- Start with __mg for 2 weeks before increasing to __mg by week 3 and ___mg/day by week 5
25mg; 50mg; 100mg / day
for lamotrigine/Lamictal- Start with 25mg for 2 weeks before increasing to 50mg by week 3 and 100mg/day by week 5
How long does it take for lamotrigine/Lamictal to work? Need to titrate slowly or doesn’t matter?
several weeks; titrate slowly
How long does it take to work for lamotrigine/Lamictal to work: May take several weeks to improve bipolar depression (have to titrate slowly given concerns for Stevens-Johnson)
Stevens-Johnsons syndrome is a dangerous side effect for which med?
lamotrigine/Lamictal
L’s bro Steve has skin issues
Weight gain is NOT a problem for which med?
lamotrigine/Lamictal
La doesn’t have serious weight issues
Pts should be aware that lamotrigine can [decrease or increase] progestin levels and result in contraceptive failure
decrease
patients should be aware that lamotrigine can DECREASE progestin levels and result in contraceptive failure
brand name for gabapentin?
Neurontin, Gralise, Horizant
gabapentin brand names
my cousin Gabi is brainy-Neuron-y
How long does gabapentin take to work?
How long does gabapentin take to work?
May reduce anxiety in a variety of disorders within a few weeks;
2 weeks for bipolar patients that may respond to Gabapentin
Monitor for neurotoxicity and movement disorders (EPS) with antipsychotics (esp Haldol) when used in conjunction with this med
lithium
Monitor for neurotoxicity and movement disorders (EPS) with antipsychotics (esp Haldol) when used in conjunction with lithium
antipsychotics + lithium = no good! need to monitor!
brand name for oxcarbazepine
Trileptal
brand name for topiramate
Topamax
med associated w/ cleft lip and palate
topiramate/Topamax
