Mood stabilizers

Question 1

What are the mood stabilizers?

Answer 1

1. Lithium (1st line for Bipolar)
2. Valproate
3. Carbamazepine

Question 2

Indications for moods?

Answer 2

1st line for Manic Depression (Bipolar 1>2)

Question 3

Do you typically use Lithium with Valproate or Carbamazapine?

Answer 3

Yes

Question 4

MOA Lithium?

Answer 4

??? maybe inhibits inositol-phosphate signaling & neurotx stimulated
*Given as a salt so lost with sweating (dehydrated).. give Gatorade

Question 5

Lithium PK?

Answer 5

• No metabolism; its an element
• Distributes to TBW & bone
• Cleared by kidney

Question 6

Lithium DDI?

Answer 6

diuretics, NSAIDs

Question 7

Lithium ADE?

Answer 7

Very narrow therapeutic window:

• Brain: tremor, ataxia, sedation
• Glands: edema, hypothyroid
• Kidney: nephrogenic DI
• Teratogen
• Skin: acne, psoriasis
• Heart: “sick sinus” syndrome (bradycardia-tachycardia)

Question 8

Valproate MOA?

Answer 8

4 components:

1. decrease Na channels
2. decrease Ca channels
3. Increase GABA
4. Increase potassium conductance

Question 9

Valproate PK?

Answer 9

inhibits UGT; increases its own concentration

Question 10

Valproate DDI?

Answer 10

displaces phenytoin from plasma proteins

Question 11

Valproate ADE?

Answer 11

heartburn & hepatotoxicity

Question 12

Carbamazapine MOA?

Answer 12

Inhibit Na channels (prolong inactive state)

Question 13

Carbamazapine PK?

Answer 13

induces CYP; decreases its own concentration

-CYP metabolism generates 10,11 epoxide (active metabolite)

Question 14

Carbamazapine DDI?

Answer 14

• CYP inducer makes it react with many drugs

- decreased OCP efficacy is RED FLAG

Question 15

Carbamazapine ADE? (4)

Answer 15

1. Aplastic anemia
2. Rash
3. Ataxia
4. Diplopia