Mood Stabilizers

Question 1

Only one that decreases suicidality?

Answer 1

Lithium

Question 2

Mood stabilizers?

Answer 2

1) Lithium
2) Valproate
3) Lamotrigine
4) Carbamazepine

Question 3

Prior to starting lithium, you must do what?

Answer 3

1) ECG
2) Basic chemistries
3) TFTs
4) CBC
5) Pregnancy test
6) Kidney function

Question 4

Onset of action for lithium?

Answer 4

5-7 days

Question 5

How often should blood levels be checked for lithium?

Answer 5

After 5 days, then every 2-3 days until therapeutic

Question 6

Therapeutic range for Li?

Answer 6

0.6-1.2

Question 7

Toxic Li?

Answer 7

> 1.5

Question 8

Lethal Li?

Answer 8

> 2.0

Question 9

Factors that affect Li levels?

Answer 9

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)

Question 10

Useful for mixed episodes and rapid-cycling bipolar?

Answer 10

Carbamazepine

Question 11

Onset of action for carbamazepine?

Answer 11

5-7 days

Question 12

What must be obtain before starting carbamazepine?

Answer 12

1) CBC

2) LFTs

Question 13

AEs of carbamazepine?

Answer 13

1) GI and CNS (most common)
2) SJS
3) Leukopenia, hyponatremia, aplastic anemia, thrombocytopenia, agranulocytosis
4) Hepatitis
5) NTDs

Question 14

Carbamazepine OD sxs?

Answer 14

Confusion, stupor, motor restlessness, ataxia, tremor, nystagmus, twitching, vomiting

Question 15

Valproic acid uses?

Answer 15

Mixed episodes of bipolar, rapid cycling

Question 16

What must you monitor with valproate?

Answer 16

1) CBC

2) LFTs

Question 17

When should drug levels be checked for valproate?

Answer 17

After 3-5 days

Question 18

Normal range for valproate?

Answer 18

50-150 micrograms/mL

Question 19

Lamotrigine uses?

Answer 19

Bipolar depression (not acute mania)

Question 20

AEs of lamotrigine?

Answer 20

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

Question 21

As effective in mood disorders as carbamazepine but better tolerated and less risk of rash and hepatitis?

Answer 21

Oxcarbazepine

Question 22

Helpful in impulse control disorder and anxiety?

Answer 22

Topiramate

Question 23

AEs of topiramate?

Answer 23

1) Weight loss
2) Hypochloremix, non-anion gap MA
3) Kidney stones
4) Cognitive slowing