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Meds > mood stabilizers > Flashcards

mood stabilizers Flashcards

1
Q

what are the 5 main mood stabilizers

A

carbamazepine
lamotrigine
lithium
oxcarbazepine
valproate

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2
Q

brand name of carbamazepine

A

tegretol

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3
Q

brand name of lamotrigine

A

lamictal

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4
Q

brand name of lithium

A

eskalith

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5
Q

brand name of oxcarbazepine

A

trileptal

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6
Q

brand name of valproate

A

depakote

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7
Q

carbamazepine upward titration

A

start 200mg BID w/ food
increase by 200mg qd divided doses at weekly intervals

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8
Q

dosage range for carbamazepine

A

400-1200mg for bipolar

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9
Q

FDA approved uses for carbamazepine

A

acute/mixed mania

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10
Q

off label uses for carbamazepine

A

bipolar depression and maintenance

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11
Q

what two meds are particularly useful for rapid cycling

A

carbamazepine and lamotrigine

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12
Q

labs prior to starting carbamazepine

A

CBC
CMP
TSH
LFT

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13
Q

labs to monitor with carbamazepine

A

CBC
LFT
renal panel
TSH

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14
Q

pregnancy risk of carbamazepine

A

avoid
give all child bearing age women folate

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15
Q

sedation considerations with carbamazepine

A

very sedating
ER can decrease sedation

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16
Q

contraindications for carbamazepine

A

bone marrow suppression

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17
Q

what is unique about carbamazepine

A

it is a subtrate and an inducer of CYP450 3A4 so dosage must be increased after long term use

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18
Q

which meds are decreased by carbamazepine

A

birth control
caffeine
olanzapine
clozapine
duloxetine
mirtazapine
luvox

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19
Q

severe side effects of carbamazepine

A

stevens johnson syndrome
aplastic anemia
agranulocytosis

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20
Q

how long should you try lamotrigine before abandoning

A

10-12 weeks

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21
Q

upwards titration of lamotrigine

A

25mg x2wks
50mg x2 wks
100mg x1 wk
200mg on wk 6

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22
Q

titration of lamotrigine when given with valproate

A

25mg qod x2 wks
25mg qd x2 wks
50mg x1 wk
100mg wk6

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23
Q

interaction between lamotrigine and valproate

A

valproate doubles the concentration of lamotrigine

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24
Q

FDA approved uses for lamotrigine

A

Bipolar 1

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25
Q

off label uses for lamotrigine

A

MDD adjunct

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26
Q

effect of lamotrigine on UDS

A

can cause false positive for PCP

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27
Q

pregnancy risk of lamotrigine

A

avoid

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28
Q

dc taper for lamotrigine

A

taper over at leat 2 weeks unless rash develops then taper over 2 days

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29
Q

severe side effects of lamotrigine

A

stevens johnson syndrome
blood dyscrasias
aseptic meningitis

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30
Q

lamotrigine and oral contraceptives

A

birth control decreases effectivenss of lamotrigine

31
Q

when should you be cautious with lamotrigine

A

renal, hepatic, and cardiac impairment

32
Q

initial dose for lithium

A

300mg BID or TID then titrate based on serum levels

33
Q

therapeutic lithium levels for mania

A

1-1.5

34
Q

therapeutic lithium levels for depression

A

0.6-1

35
Q

therapeutic lithium levels for bipolar

A

0.7-1

36
Q

FDA approved uses for lithium

A

acute/mixed bipolar mania and bipolar maintenance

37
Q

off label uses for lithium

A

bipolar depression
adjunct for treatment resistant depression

38
Q

serum lithium level in the elderly

A

<0.6 is usually still effective

39
Q

labs to monitor with lithium

A

CBC w/ diff
BMP
TSH
calcium
fasting glucose

40
Q

what should you monitor if a patient is over 50 and taking lithium

A

ECG

41
Q

how often should you draw lithium levels

A

every 1-2 weeks until therapeutic
q2-3 months x6 months
q6-12 months thereafter

42
Q

what is important about the blood sample for lithium levels

A

must be trough

43
Q

pregnancy risk with lithium

A

avoid

44
Q

what if a patient on lithium is going to have ECT

A

hold lithium x2 day d/t increased risk of delirium

45
Q

signs of lithium toxicity

A

tremor
slurred speech
poor coordination
vomiting
diarrhea
excessive sedation

46
Q

which medications can increase lithium toxicity

A

carbamazepine
methyldopa
phenytoin
metronidazole
NSAIDs

47
Q

what can help with a lithium tremor

A

low dose propranolol

48
Q

dc taper for lithium

A

taper slowly over 3 months

49
Q

lithium and SSRIs

A

can exacerbate tremor and increase risk of serotonin syndrome

50
Q

contraindications for lithium

A

GFR <50
severe cardiac impairment

51
Q

intial dose for oxcarbazepine

A

600mg in divided doses

52
Q

upwards taper of oxcarbazepine

A

increase by 300mg daily q3 days to a max of 2400mg

53
Q

dosage range for oxcarbazepine

A

1200-2400mg qd

54
Q

Only FDA approved use for oxcarbazepine

A

partial seizures

55
Q

off label use for oxcarbazepine

A

bipolar

56
Q

geriatric considerations with oxcarbazepine

A

lower doses d/t reduced creatinine clearance

57
Q

pregnancy risk with oxcarbazepine

A

avoid

58
Q

dose of oxcarbazepine with renal disease

A

decrease initial dose by 1/2

59
Q

how to dc oxcarbazepine

A

taper slowly

60
Q

what is different about oxcarbazepine’s side effects compared to other mood stabilizers

A

less sedation and weight gain than other mood stabilizers

may cause life threatening hyponatremia

61
Q

oxcarbazepine and oral contraceptives

A

oxcarbazepine decreases effectiveness of birth control

62
Q

initial dosage of valproate if mania is NOT acute

A

500mg qd

63
Q

initial dose of valproate for acute mania

A

15mg/kg in 2 divided doses

64
Q

FDA approved uses for valproate

A

acute/mixed mania

65
Q

off label uses for valproate

A

seizures
migraine prophylaxis
bipolar depression

66
Q

geriatric considerations for valproate

A

reduce starting dose and titrate slowly
monitor fluid/nutritional intake

67
Q

initial labs for valproate

A

CBC
coagulation tests
LFTs
pregnancy test
BMI

68
Q

labs to monitor with valproate

A

LFTs and platelets for first few months then q6-12 months

69
Q

pregnancy risk for valproate

A

avoid

70
Q

when should you change from valproate

A

if weight gain exceeds 5% of starting weight

71
Q

dc valproate

A

must taper slowly

72
Q

contraindications for valproate

A

pancreatitis
liver disease
urea cycle DO

73
Q

valproate and birth control

A

birth control decreases effectiveness of valproate

Meds (12 decks)

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