Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharm- Antipsychotics > Mood Stabilizers > Flashcards

Mood Stabilizers Flashcards

1
Q

Complete work-up prior to diagnosis of BD

A

Physical exam
Basic laboratory work-up (CBC w/diff, thyroid function, electrolytes)
Toxicology screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

2 things that need to be ruled out before diagnosis?

A

Medical or drug-induced causes

Other psychiatric diagnoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Catecholamine Hypothesis of BD

A

Mania may be related to excessive NE and DA

Depression may be related to relative deficits in NE, 5-HT, and DA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Permissive Theory of BD

A

In both mania and depression there is an underlying decrease in 5-HT with increased NE activity resulting in mania or decreased NE activity resulting in depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

4 treatment goals for Bipolar disorder

A

Resolve acute symptoms
Facilitate patient’s return to pre-morbid functioning (social and occupational)
Prevent further episodes of mania and/or depression
Pharmacotherapy is cornerstone of treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Nonpharm Therapy for Bipolar

A 
Nutrition
Sleep (decrease need for sleep with hypomanic)
Exercise
Stress reduction
Mood charting
Psychoeducational programs
Self-help, support groups
ECT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

5 MC used mood stabilizers in practice

A 
Lithium (Eskalith®, Lithobid®)
Valproic acid (Depakene®); divalproex sodium (Depakote®)
Lamotrigine (Lamictal®)
Carbamazepine (Tegretol®; Equetro®)
Oxcarbazepine (Trileptal®)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Lithium is the drug of choice for?

A

“classic” mania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lithium (2)

A

FDA approved for treatment of acute mania and maintenance treatment of bipolar I disorder
Shown to reduce risk of suicide in patients with depressive episodes in BD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lithium is less effective than?

A

Less effective than VA or CBZ for mixed episodes or rapid cycling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lithium effects what?

A

affects NE, GABA, glutamate and serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the pharmacokinetics for Lithium?

A 
Rapidly absorbed
Widely distributed
No protein binding
Not metabolized
Excreted unchanged in the urine
T ½ = 18-27 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lithium Adverse Effects early in therapy

A

GI distress (e.g., nausea, vomiting, dyspepsia, diarrhea)
Muscle weakness and lethargy (30%)
Polydipsia with polyuria and nocturia (70%)
Headache, memory impairments,
Hand tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lithium: Adverse Effects later is therapy

A 
renal changes
nephrogenic diabetic insipidous
hypothyroid
wt gain
sexual dysfunction
cardia effects
dermatologic effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What needs to be monitored with nephrogenic diabetic insipidous during lithium use?

A

Monitor potassium levels

Monitor for lithium toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Monitoring Parameters (baseline and maintenance) for Lithium?

A 
Plasma concentration taken 8-12 hours after last dose 
Acute Mania: 
Every 4-5 days when first started (until stable)
Maintenance: 
           Every 3 months for first 6 months
           Every 6 months thereafter
Renal Function 
Thyroid Function
ECG
CBC
Serum electrolytes
Pregnancy test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

At plasma concentrations of lithium > 1.5 mEq/L

A 
GI symptoms 
Decrease in coordination
Severe hand tremor
Unstable gait
Slurred speech
Muscle twitching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

At plasma concentrations of lithium > 2.0

A

Seizures, cardiac arrhythmias, neurological impairment, kidney damage, coma, death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Situations that predispose the patient for lithium toxicity?

Treat with?

A 
Sodium restriction
Dehydration
Vomiting, diarrhea
Drug interactions that  lithium clearance
Treat with dialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Increase lithium levels (decrease lithium clearance)

Lithium Drug-Drug Interactions

A

Thiazide diuretics, NSAIDs, ACE inhibitors, fluoxetine, salt-restricted diets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Lithium Drug-Drug Interactions

decrease lithium levels (increase lithium clearance)

A

Caffeine, theophylline

22
Q

Pregnancy and lactation associated with lithium? (4)

A

Crosses the placenta
Pregnancy risk category D
May cause “floppy” infant syndrome
Present in breast milk

23
Q

Lithium should be maintained at what?

A

Maintain patient on lowest therapeutic dose
Maintain adequate hydration
Avoid in patients with pre-existing renal disease

24
Q

Valproic Acid is FDA approved for?

A

FDA approved for treatment of acute mania in bipolar I disorder
Better efficacy for mixed states and rapid cycling compared to lithium

25
Valproic Acid is not FDA approved for?
maintenance treatment of BD but commonly used as monotherapy or in combination with other agents (e.g., lithium, CBZ, antipsychotics)
26
Valproic Acid MOA
``` increases GABA levels in CNS Antikindling properties (may  rapid cycling and mixed states) ```
27
What do you need to know about valproic acid?
what it is used for | migraine prophylaxis, bipolar, seizures
28
Valproic Acid: Adverse Effects (8)
``` GI upset Tremor Rash Alopecia Somnolence Dizziness Weight gain Mild and transient  in LFTs ```
29
Drug interaction with Valproic Acid
Potential drug-drug interaction when used concomitantly with lamotrigine VA inhibits lamotrigine metabolism by competing with hepatic glucuronidation enzyme site
30
Pregnancy and Lactation for Valproic Acid
Pregnancy risk category D: risk of neural tube defects (1-5%) during 1st trimester Considered compatible with breastfeeding
31
Monitoring (Baseline and maintenance) for Valproic Acid
Therapeutic plasma concentrations Acute Mania and Maintenance: 50-125 mcg/mL (trough) Toxicity :Serum levels > 200 mcg/mL (can occur as low as 150 mcg/mL) Visual hallucinations, new onset tremor, motor restlessness, deep sleep, coma CBC with differential Chemistry panel with electrolytes Liver function tests
32
Lamotrigine
FDA approved for maintenance treatment of bipolar I disorder Has both antidepressant and mood-stabilizing effects May have efficacy for prevention of bipolar depression
33
Lamotrigine MOA
Modulates or decreases glutamate release | Antikindling properties
34
Lamotrigine drug interaction
When combined with VA, initial and titration dosing should be decreased by 50%
35
Lamotrigine Pharmacokinetics
Metabolized via glucuronide conjugation (no CYP involvement) T ½ = 25 hrs (’d to 59 hrs with VA) No well-established therapeutic range
36
Lamotrigine adverse effects
``` Headache, nausea, dizziness, ataxia, diplopia, drowsiness, tremor, rash Weight neutral (vs. Li+ and VA) Rash can progress to Stevens-Johnson Syndrome with rapid dose escalation ```
37
Lamotrigine in Pregnancy
Pregnancy risk category C | Not recommended in breast-feeding
38
Carbamazepine MOA
Modulates or decreases glutamate release | Antikindling properties
39
Carbamazepine
Used as monotherapy or in combination with other agents (e.g., lithium, VA, antipsychotics) for acute and maintenance therapy – NOT 1st Line autoinducer 2-3wks before effects seen
40
Carbamazepine Pharmacokinetics
Hepatically metabolized via CYP 2C8 and 3A4 Pan-inducer of CYP Induces its own metabolism T ½ 25-65 hrs initially; 12-17 hrs with multiple dosing Therapeutic serum levels: Acute: 4-12 mcg/mL Maintenance: 4-8 mcg/mL
41
Carbamazepine Adverse effects
``` Hyponatremia Weight gain Agranulocytosis GI CNS toxicity ```
42
Carbamazepine Toxicity
(at > 15 mcg/mL) | Ataxia, choreiform movements, diplopia, nystagmus, cardiac conduction changes, seizures, coma)
43
Carbamazepine pregnancy and lactation
Pregnancy risk category D Craniofacial deformities, spina bifida, low birth weight Considered compatible with breast feeding
44
Carbamazepine drug interactions
Pan-inducer | increases metabolism of many medications
45
Monitoring parameters of carbamazepine
Serum levels every 1-2 weeks during first 2 months of therapy; then every 3-6 months during maintenance 10-12 hours post-dose and at least 5-7 days after a dosage change CBC with differential Liver function tests Serum electrolytes Dermatologic monitoring
46
Oxcarbazepine
10-keto analog of carbamazepine May have fewer adverse effects and be better tolerated than CBZ Not FDA approved for treatment of bipolar disorder – NOT 1st line
47
Oxcarbazepine Pharmacokinetics
``` Hepatic conjugation (? Oxidation at CYP450) T ½ = 9 hrs (active metabolite) No established therapeutic range ```
48
Oxcarbazepine Pregnancy risk?
Pregnancy risk category C; not recommended in breastfeeding
49
Acute Mania: Monotherapy or adjunctive therapy antipsychotics for bipolar disorder
Aripiprazole - Haloperidol Olanzapine - Quetiapine Risperidone - Ziprasidone Lithium or valproic acid + antipsychotic > efficacy than any of these agents alone
50
Benzodiazepines in Bipolar Disorder
Can be used as an alternative to or in combination with antipsychotics for acute mania Can ↓ agitation, anxiety, panic, insomnia symptoms Alternative to mood stabilizers in 1st trimester of pregnancy Lorazepam (Ativan®): intramuscular and oral formulations
51
Antidepressants in Bipolar Disorder
Concern of mood switching in patients with bipolar depression Can precipitate a manic episode Higher with TCAs or venlafaxine Recent data suggests adjunctive antidepressant therapy (with mood stabilizers) no better than placebo for acute bipolar depression

Pharm- Antipsychotics (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions