Mood Stabilizers Flashcards
Mood stabilizers are used to tx =
Acute Mania
Prevent relapses of manic episodes
2º indications for mood stabilizers =
- Potentiation of antidepressants in patients with major depression refractory to mono therapy
- Potentiation of antipsychotics
- Enhancement of abstinence in EtOH tx
- Treatment of aggression and impulsivity
Drug of choice for mania =
Lithium
Indications for Lithium =
- Bipolar Disorder
- Cyclothymia
- Unipolar depression
Metabolism site for lithium =
Kidney
Tests which should be performed before patient started on Lithium =
- ECG
- Basic Chemistries
- Thyroid function tests
- CBC
- Pregnancy Test
Onset of action of Li =
1 week
Blood levels of Li correlate with efficacy?
Yes, therefore you should always check the blood levels and titrate to a therapeutic level
Drawback of Li =
- Side effects
- Narrow therapeutic index
Side effects of Li =
- Death
- B9 Leukocytosis
- AMS
- Course tremors
- Convulsions
- Fine tremor
- Nephrogenic diabetes insipidus
- GI disturbance
- Weight gain
- Sedation
- ECG changes
- Ebstein’s Anomaly
Ebstein’s Anomaly =
Cardiac defect in newborns in mothers who have taken Li
Indications for Carbamazepine =
- Mixed episodes of mania and depression
- Rapid-cycling bipolar disorder
- Trigeminal Neuralgia
MOA of carbamazepine =
Blocking Na channels and inhibiting action potentials
Onset of action of carbamazepine =
1 week
What must be obtained and monitored continuously if a ptn receive carbamazepine =
- CBC
- LFTs
Carbamazepine side effects =
- GI sx
- CNS depression
- Steven-Johnson Syndrome
- Leukopenia
- Hyponatremia
- Aplastic anemia
- Thrombocytopenia
- Agranulocytosis
- Hepatitis
- Tetratogen
Carbamazepine metabolism features =
- Many drug interactions with cytP450 drugs
- Autoinduces its own metabolism
Signs of carbamazepine toxicity =
- Confusion
- Stupor
- Motor restlessness
- Nystagmus
Indications for valproic acid =
- Bipolar Disorder
- Rapid cycling bipolar disorder
What to monitor with valproic acid =
CBC
LFTs
Lamotrigine
- Class =
- MOA =
- Indications =
- Side effects =
- Important drug interactions =
Class:
- Anticonvulsant / Mood stabilizer
MOA:
- Sodium channels modulating glutamate and aspartate
Indications:
- Bipolar DEPRESSION
Side Effects:
- Steven Johnson Syndrome
- Dizziness
- Sedation
- Headaches
Drug Interactions:
- Lamotrigine decreases valproate levels
- Valproate increases Lamotrigine levels
How to avoid Steven Johnson Syndrome =
Start on low doses of the medication and titrate up slowly
Oxcarbazepine
- Class
- Perks
Class =
- Mood stabilizer and anticonvulsant
Perks =
- Better mood stabilizer than carbamazepine
- Less hepatic toxicity and rash than carbamazepine
Gabapentin
- Class
- Indications
Class:
- Anticonvulsant / Mood stabilizer
Indications:
- Adjunctively to help with sleep and anxiety
- No good for bipolar disorder
Pregabalin
- Class
- Indications
Class
- Anticonvulsant / Mood Stabilzer
Indications:
- GAD
- Fibromyalgia
- No good for bipolar disorder
Tiagabine
- Class
- Indications
Class = anticonvulsant / Mood stabilizer
Indications = Anxiety
Topiramate
- Class
- Indications
- Side effects
Class = anticonvulsant / Mood stabilizer
Indications:
- Anxiety
- Reduce cravings for alcohol
- SSRI-refractory bulimia nervosa
- Impulse control disorder
Side effects:
- Cognitive Slowing
- Weight Loss
- Hypochloremic, non-anion gap metabolic acidosis
- Kidney Stones
Drug potentially causing pancreatitis =
Valproic Acid / Divalproex sodium
Drug likely causing increased urination =
Lithium, since it can cause nephrogenic diabetes insipidus.
Side effects of valproic acid?
- Weight gain
- Alopecia
- Pancreatitis
- Hepatotoxicity
- Elevated ammonia
- Thrombocytopenia
- Neural tube defects
