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69:252 Psychopharmacology > Mood Stabilizers > Flashcards

Mood Stabilizers Flashcards

1
Q

Biogenic Amine Hypothesis
Chronobiologic Theories
Sensitization and Kindling theory
Genetic Factors

A

Theories of Mood Disorders (Bipolar Disorder)

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2
Q

Monoamine – neurotransmitters for depression & mania (specific)

A

Biogenic Amine Hypothesis

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3
Q

Circadian rhythm related

A

Chronobiologic Theories

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4
Q

Electrical storm of sensitization in the brain & kindling – more action potential stuff happening, brain is ready to have rapid firing (kindled and ready to go) – affects all parts of the brain (hypothalamus is controlled by where mood and kindling is controlled). This is why antiseizure medications are used to treat bipolar disorder – this theory is why

A

Sensitization and Kindling theory

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5
Q

Strong likelihood of genetic factors – if family members have schizophrenia, higher risk of bipolar

A

Genetic Factors

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6
Q

Anti-Mania medications (mood stabilizer medications)
Anticonvulsant medication
Antipsychotic medication

A

Treatment of Bipolar Disorders

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7
Q

______ is anti-mania medication

A

Lithium

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8
Q

Generally used short term, acute episodes vs long term maintenance use

A

Antipsychotic medication

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9
Q

Anti-mania

A

lithium carbonate (Carbolith)

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10
Q

Used to be used as a table salt – ________ toxicity
Has relationship w sodium

A

lithium

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11
Q

Modify nerve cell function
Also thought to increase the level of inhibitory neurotransmitter GABA (Gamma- aminobutyric acid)

A

Anticonvulsants - Drugs that Suppress Sodium Influx

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12
Q

Decrease dopamine levels when a person is experiencing mania
Often used in combination with other mood stabilizers

A

Antipsychotics

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13
Q

May be administered concurrently with mood stabilizers to treat Acute Bipolar I Disorder with Depressive Symptoms AND Acute Bipolar II Disorder with Depressive Symptoms

Need to be administered with the mood stabilizer
medications to prevent rapid cycling from depression to mania

A

Antidepressants

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14
Q

ANTIDEPRESSANTS USED AS _________ FOR MOOD STABILIZATION:

Selective Serotonin Reuptake Inhibitors
Selective Serotonin and Norepinephrine Reuptake Inhibitors
Atypical Antidepressants (bupropion, mirtazapine, trazadone & moclobemide)

A

ADJUNCTS

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15
Q

Antidepressants used with caution – More common with Acute ___________

More common with bipolar II because more depressive symptoms – not fully mania
Should be administered concurrently w a mood stabilizer

A

Bipolar II

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16
Q

ABSORPTION
GI Tract
DISTRIBUTION
Same as water **
Crosses the blood brain barrier slowly
Widely distributed through the body
METABOLISM
Liver
EXCRETION
Kidneys
Usually 80% of filtered Lithium is reabsorbed **
Cross placenta and enter breast milk

A

Lithium

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17
Q

Does not bind to serum proteins – nonprotein binding
Long term use can be very disruptive to the kidneys. Toxicity WILL damage the kidneys – there is a cumulative effect with each time they get into toxicity.

A

Lithium

18
Q

Low salt intake, dehydrated, low sodium concentration in the blood – then MORE than the 80% of _____ will be reabsorbed. Increases levels and increased levels of toxicity.

A

Lithium

19
Q

Acute: 900- 2400 mg
Maintenance: 400 – 1200mg

A

Lithium carbonate

20
Q

Lithium
Valproic acid/Divalproex (Epival)
Paliperidone (Invega)
Risperidone (Risperdal)
Quetiapine (Seroquel)
Aripiprazole (Abilify)
Asenapine (Saphris)

A

1st Line Acute Mania Treatment Options

21
Q

Lithium
Valproic acid/Divalproex
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Quetiapine + Lithium or Divalproex
Aripiprazole + Lithium or Divalproex
Aripiprazole

A

1st Line Maintenance Treatment Options

22
Q

Serum Drug Levels are required with LiCO3
Baseline bloodwork:
- Renal
- Cardiac
- Thyroid
- Electrolytes

A

Lithium Carbonate (LiCO3)

23
Q

Upon initiation of LiCO3 - blood levels are required q 2- 3 days
Maintenance: every couple of months (if stable)
Lithium blood levels are best done 8 to 12 hours after the last dose
Acute Therapeutic Range is 0.6 – 1.2 mEq/L (mmol/L)
Maintenance Therapeutic Range 0.6-1.0mEq/L

A

Lithium Carbonate (LiCO3)

24
Q

Lithium and ________ are monovalent positive ions

Sodium levels need to be taken on a regular basis
Sodium levels should remain normal (135-145 mmol/L)
Patients should be advised to maintain a normal salt intake and to avoid over-hydration or dehydration

A

Sodium

25
Q

decreases lithium level

A

Overhydration

26
Q

increases lithium level

A

Dehydration

27
Q

Abdominal pain
Tremor of hands
Fatigue
GI upset
Vertigo
Weight gain
Thyroid abnormalities
ECG changes
Dermatological changes

A

<1.0 Lithium blood level

28
Q

Polyuria
Increased drowsiness
Blurred vision
Muscular weakness
Tremors
Diarrhea
Vomiting

A

1.0-2.0 Lithium blood level

29
Q

Confusion/disorientation
Delirium
Seizures
Nystagmus
Kidney failure
Tachycardia
Coma/death

A

> 2.0 Lithium blood level

30
Q

Lithium toxicity ______ mEq/L (mmol/L)+

A

1.2-1.5

31
Q

Toxicity Manifestations Include:
GI discomfort, tremor, confusion, fatigue, seizures and possibly death

A

Lithium Toxicity

32
Q

Treatment:
Immediately notify the prescriber
Withhold Lithium
Obtain a Blood Sample to measure the lithium, sodium, and kidney function
Emergency medical treatment
Assess for neurological damage
IV hydration

A

Lithium Toxicity

33
Q

Brain Damage
Conditions requiring reduced sodium intake
Renal Impairment
Cardiac Impairment

A

Lithium contraindications

34
Q

NSAIDS
Thyroid Conditions
Psoriasis
Hypercalcemia
Diabetes
Parkinson’s Disease
Surgery – surgeon needs to be notified that the client is on Lithium
Cannabis

A

Lithium precautions

35
Q

Lithium Toxicity Risk: Increases with _______ depletion and needs to be carefully monitored (vomiting, diarrhea, use of diuretics, heavy sweating etc.)

A

sodium

36
Q

Alcohol/ diuretics
INCREASED dehydration/ fluctuating sodium levels
SSRI
INCREASED Risk of serotonin syndrome
Carbamazepine/phenytoin
INCREASED Risk of CNS toxicity
Haldol
INCREASED encephalopathy syndrome
Phenothiazines (Typical Antipsychotics)
INCREASED Risk for altered response from either drugs

A

Lithium Carbonate Interactions

37
Q

Lithium and Haldol – contraindicated/great caution – increased risk of ____________

A

encephalopathy

38
Q

___________ – increase dehydration / fluctuating sodium levels

A

Alcohol/diuretics

39
Q

_________ – increase risk encephalopathy syndrome.
Encephalopathy is a group of conditions that cause brain dysfunction. Brain dysfunction can appear as confusion, memory loss, personality changes and/or coma in the most severe form.
- vision changes, headache, weakness, tremors, lethargy, shutting down and sleeping.

A

Haldol

40
Q

__________ used in an acute episode – rapid tranquilization & increase safety of the person experience & and also the care provider
- mixed features of irritability can occur w mania
- not all sunshine and rainbows
- people may do impulsive things (try to fly) – risk of death, when people try to stop you and bipolar people can become hostile quickly

A

Haldol

41
Q

Blood levels (renal intake and output & function, cardiac, electrolytes, thyroid) therapeutic effect at lowest dose (trough). Serum lithium levels – tolerable range and not in toxicity. Serum lipid levels (weight gain), waist circumference. Blood pressure (orthostatic hypotension).
Hydration is important because dehydration increases level of lithium in their body, increase in toxicity. Knowing about exercise and interests i.e., hot yoga.
Lithium toxicity signs. Earlier signs (aside from seizure). Any hint of lithium toxicity - so we can prevent irreparable damage.

A

Client teaching for Lithium

42
Q

Lithium Carbonate
*Caution with clients with critical illness, renal, hepatic impairment - lower doses will be necessary
*Lithium level 0.4 to 0.6 in older adults

A

Older adult lithium considerations

69:252 Psychopharmacology (14 decks)

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