Mood Stabilizers

Question 1

TCA MOA (Imipramine)

Answer 1

Blocks uptake of norepinephrine

Question 2

TCA contraindications

Answer 2

Cardiovascular disease and hypertension

Question 3

TCA side effects

Answer 3

Orthostatic hypotension, sedation, anticholinergic effects, cardiotoxicity

Question 4

SSRI MOA (Fluoxetine)

Answer 4

Blocks serotonin reuptake enhancing serotonin Transmisson at serotonergic synapse.

Question 5

SSRI contraindications

Answer 5

Hypersensitivity, Concurrent MAOI therapy

Question 6

SSRI side effects

Answer 6

Dry mouth, blurred vision, insomnia, GI disturbances, sexual dysfunction

Question 7

SNRI MOA (Venlafaxine)

Answer 7

Blocks serotonin and norepinephrine reuptake increasing availability at synapse.

Question 8

SNRI contraindications

Answer 8

Hypersensitivity, Concurrent MAOI therapy

Question 9

SNRI side effects

Answer 9

Dry mouth, blurred vision, insomnia, GI disturbances, sexual dysfunction.

Question 10

MAOI (Phenelzine) MOA

Answer 10

By inhibiting MAO enzyme levels of norepinephrine, dopamine, epinephrine, and serotonin rise.

Question 11

MAOI use

Answer 11

Atypical depression

Question 12

MAOI contraindications

Answer 12

Concurrent TCA use, some OTC drugs, major food interactions

Question 13

MAOI drug interactions

Answer 13

CNS stimulants, sympathomimetics like vasoconstrictors and cold medicines w/phenylephrine or pseudoephedrine

Question 14

MAOI food interactions

Answer 14

Aged cheese, cream, yogurt, coffee, chocolate, bananas, raisins, Italian green beans, liver, pickled foods, sausage, soy sauce, yeast, beer, red wines.

Question 15

MAOI side effects

Answer 15

Insomnia, orthostatic hypotension, anticholinergic effects.

Question 16

NDRI MOA

Answer 16

Blocks synaptic reuptake of norepinephrine and dopamine.

Question 17

NDRI contraindications

Answer 17

Seizure disorders, eating disorders.

Question 18

NDRI side effects

Answer 18

Insomnia, anorexia, weight loss, tremor

Question 19

Lithium MOA

Answer 19

Alteration of ion transport in muscle and nerve cells; increased receptor sensitivity to serotonin

Question 20

Lithium contraindications

Answer 20

Hypersensitivity, diuretics

Question 21

Lithium side effects

Answer 21

Headache, metallic taste, dry mouth, GI disturbances, dizziness

Question 22

Lithium patient teaching

Answer 22

Daily weight, Lithium alters blood glucose, take after meals, frequent urination/nausea/thirst are expected during the first few days, report signs of toxicity (diarrhea, drowsiness, muscle weakness, tremor, uncoordinated movements, vomiting), inform provider of pregnancy and breastfeeding is not recommended.

Question 23

Imipramine teaching

Answer 23

Anticholinergic effects, assess frequently during first 2hrs of therapy, effects in 2-3 weeks, avoid abrupt withdrawal, take at bedtime if taking once daily, report chills/dizziness/excess sedation/fever/palpitations/allergic reaction/sore throat/trouble urinating, avoid alcohol, eat frequent and small meals, possible photosensitivity, report dry mouth after two weeks.

Question 24

Fluoxetine teaching

Answer 24

Patients should be screened for bipolar prior to drug therapy, monitor for signs of depression, monitor for signs of GI bleeding, monitor for difficulty concentrating/headache/memory impairment/unsteadiness/weakness, taper off, may cause hypoglycemia during and hyperglycemia after, may take several weeks for effect, watch closely for suicidal tendencies, notify prescriber of pregnancy.

Question 25

Venlafaxine teaching

Answer 25

Do not use if pregnant or breastfeeding, monitor BP, can cause false-positive for amphetamine and PCP, monitor closely for bleeding, take w/food and full glass of water, can sprinkle capsule contents into applesauce, avoid alcohol, tell prescriber of all OTC medications, avoid aspirin and NSAIDS