Mood stabilizers Flashcards
How does lithium work as a mood stabilizer?
Inhibits adenylate cyclase enzyme.
Name side effects of lithium.
Edema, leukocytosis, nausea, tremor, hypothyroidism, diabetes insipidus (weight gain, thirst, frequent urination), acne. Toxic Li levels can cause alterations in consciousness, seizures, coma, and death.
What tests are required before and during Li prescription?
Before Li therapy: WBC, electrolytes, thyroid function test, renal function tests (BUN, serum Cr, spec gravity), echocardiogram, and b-HCG if female. During Li therapy: Monitor Li levels q 3 mo, TSH and creat. q 6 mo, pregnancy test and ECG yearly.
What medication can decrease tremors caused by Li?
Propranolol.
Name 7 mood stabilizing agents.
Lithium, valproate, divalproex (Depakote), carbamazepine, lamotrigine (Lamictal), gabapentin (Neurontin), topiramate (Topamax).
How do valproate and divalproex work as mood stabilizers?
Opens chloride channels.
Name valproate and divalproex side effects.
TERATOGENIC, neural tube defects in pregnancy. Thrombocytopenia, pancreatitis, weight gain, hair loss, GI distress, congnitive dulling.
How does carbamazepine work as a mood stabilizer?
Inactivates sodium channels.
Review carbamazepine side effects.
Agranulocytosis! Must obtain pretreatment CBC and draw blood tests frequently during treatment. Carbamazepine is potent inducer of CYP450 system. Also causes nausea, vomiting, dizziness, drowsiness, slurred speech, leukopenia, cognitive slowing, and craniofacial defects in newborns.
Review lamotrigine side effects.
Leukopenia, hepatic failure, nausea, vomiting, diarrhea, dizziness, somnolence. Can sometimes have antidepressant effect.
Review gabapentin side effects.
Rash can be fatal (though the chief neurology resident had never heard of it.) Somnolence, leukopenia, fatigue, weight gain.
Review topiramate side effects.
Cognitive slowing, fatigue, memory disturbances. Numerous drug-drug interactions.
