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Exam - M - Psychiatry (Meg) > Mood stabilizers > Flashcards

Mood stabilizers Flashcards

1
Q

What are the 3 categories of mood stabilisers?

A

Lithium
Anticonvulsants
Antipsychotics

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2
Q

How do anticonvulsants work to stabilise mood?

A

They calm hyperactivity in the brain.

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3
Q

What other diseases are anticonvulsants used for?

A

Migraine

Epilepsy

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4
Q

What type of bipolar disorder reacts well to anticonvulsants?

A

Those with rapid cycles.

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5
Q

What is the 1st line treatment for bipolar?

A

Lithium

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6
Q

What is the prophylaxis for bipolar?

A

Lithium - for both manic and depressive episodes.

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7
Q

What tests must be done before starting lithium?

A

U&E
TSH
Pregnancy

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8
Q

What congenital abnormality is associated with lithium?

A

Abstains anomaly (heart defect)

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9
Q

When is lithium likely to cause a congenital anomaly?

A

1st trimester

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10
Q

When does lithium reach a steady state?

A

After 5-7 days

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11
Q

When most lithium be checked?

A

5-7 days after starting.

At least 12hrs after the last dose.

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12
Q

What is the goal level of lithium?

A

0.6-1.2

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13
Q

when must lithium, TSH and creatinine be checked?

A

Lithium - every 3 months

TSH and creatinine - every 6 months

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14
Q

What is the first line treatment for a manic episode?

A

Antipsychotics

Lithium can also be used (isn’t 1st line)

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15
Q

When is lithium indicated?

A

1st line bipolar disorder
option in acute manic episode
Unipolar depression when theres no response to antidepressants

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16
Q

What are the side effects of lithium?

A 
Nausea
Vomiting
Tremor
ADH blocked - polyuria, polydipsia 
Hypothyroidism (weight gain, cold sensitive, slow HR, mental slowness, hair loss, acne)
Intention tremor
reduced seizure threshold
Renal fibrosis
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17
Q

What are the toxic levels of lithium, mild, moderate and severe?

A 
Mild = 1.5-2
Moderate = 2-2.5
Severe = >2.5
18
Q

When should lithium not be used?

A

For someone with alcohol abuse - causes toxicity if they’re dehydrated

19
Q

What are the 3 main anticonvulsants used as mood stabilisers?

A

Valproic acid
Carbamazepine
Lamotrigine

20
Q

What condition is valproic acid given as a prophylaxis?

A

Migraine

21
Q

What are the side effects of valproic acid?

A 
Tremors
GI symptoms
Alopecia
Sedation
Weight gain
Liver toxicity
AV conduction delay
22
Q

What defects can valproic acid cause if used during pregnancy?

A

Neural tube defects

23
Q

Is valproic acid good as a prophylactic in bipolar?

A

Good as a manic prophylaxis

Not as good as lithium at depression prophylaxis

24
Q

Why might lithium be given for bipolar prophylaxis rather than lithium?

A

Better tolerated

25
Q

What tests must be done before using valproic acid?

A

LFTs
Pregnancy test
FBC

26
Q

When is a steady state achieved using valproic acid?

A

4-5 days

27
Q

When must levels of valproic acid be checked?

A

After 4-5 days

12 hours after last dose

28
Q

What is the goal for valproic acid levels?

A

50-125

29
Q

What conditions use carbamazepine as their 1st line treatment?

A

Trigeminal neuralgia
Acute mania
Mania prophylaxis

30
Q

Which patients benefit from carbamazepine?

A

rapid cyclers

31
Q

Which tests must be done before using carbamazepine?

A

LFT
FBC
ECG

32
Q

What side effects are seen using carbamazepine?

A 
Rash
double vision
ataxia
liver toxicity
Teratogenic 
Av conduction delays
Cytochrome P450 induction
Water retention (hyponatraemia)
33
Q

When is a steady stage achieved using carbamazepine?

A

after 5 days

34
Q

What are the teratogenic effects of carbamazepine?

A

Cleft pallet

Spina bifida

35
Q

When must carbamazepine be checked?

A

after 5 days
12 hours after last dose

**Must check again and change dose after 1 month - it induces its own metabolism

36
Q

What is the goal level of carbamazepine?

A

4-12mcg/ml

37
Q

What is the main thing to remember when using lamotrigine?

A

If the patient stops their medication for more than 5 days, they need to start at the lowest dose again then titrate up.

38
Q

What is the titration pattern for lamotrigine>

A

25mg daily - for 2 weeks
50mg daily - for 2 weeks
100mg daily after this

39
Q

What conditions is lamotrigine used most for?

A

Chronic pain

Neuropathic pain

40
Q

What are the side effects of lamotrigine?

A 
Blurred vision
GI 
Nausea
Vomiting
stevens johnson syndrome
41
Q

What is the correlation between anticonvulsants and LFTs?

A

Can cause an increase in LFTs.

As long as the LFT doesn’t triple, its okay.

42
Q

What is the role for lithium?

A

Its an adjuvant for antidepressants in unipolar depression

It acts as prophylaxis

Exam - M - Psychiatry (Meg) (24 decks)

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