Mood Stabilizers Flashcards
Only one that decreases suicidality?
Lithium
Mood stabilizers?
1) Lithium
2) Valproate
3) Lamotrigine
4) Carbamazepine
Prior to starting lithium, you must do what?
1) ECG
2) Basic chemistries
3) TFTs
4) CBC
5) Pregnancy test
6) Kidney function
Onset of action for lithium?
5-7 days
How often should blood levels be checked for lithium?
After 5 days, then every 2-3 days until therapeutic
Therapeutic range for Li?
0.6-1.2
Toxic Li?
> 1.5
Lethal Li?
> 2.0
Factors that affect Li levels?
1) NSAIDs (lower)
2) Aspirin
3) Dehydration (increase)
4) Salt deprivation (increase)
5) Sweating (salt loss) (increase)
6) Impaired renal function (increase)
7) Diuretics (esp thiazides)
Useful for mixed episodes and rapid-cycling bipolar?
Carbamazepine
Onset of action for carbamazepine?
5-7 days
What must be obtain before starting carbamazepine?
1) CBC
2) LFTs
AEs of carbamazepine?
1) GI and CNS (most common)
2) SJS
3) Leukopenia, hyponatremia, aplastic anemia, thrombocytopenia, agranulocytosis
4) Hepatitis
5) NTDs
Carbamazepine OD sxs?
Confusion, stupor, motor restlessness, ataxia, tremor, nystagmus, twitching, vomiting
Valproic acid uses?
Mixed episodes of bipolar, rapid cycling
What must you monitor with valproate?
1) CBC
2) LFTs
When should drug levels be checked for valproate?
After 3-5 days
Normal range for valproate?
50-150 micrograms/mL
Lamotrigine uses?
Bipolar depression (not acute mania)
AEs of lamotrigine?
1) Most common = dizziness, sedation, HA, ataxia
2) SJS in 10% of pts (most likely in first 4-6 wks)
3) Valproate increases lamotrigine levels, lamotrigine decreases valproate levels
As effective in mood disorders as carbamazepine but better tolerated and less risk of rash and hepatitis?
Oxcarbazepine
Helpful in impulse control disorder and anxiety?
Topiramate
AEs of topiramate?
1) Weight loss
2) Hypochloremix, non-anion gap MA
3) Kidney stones
4) Cognitive slowing
