Mood Stabilizers Flashcards
Drug of choice for acute mania and prophylaxis for manic and depressive episodes in bipolar and schizoaffective Cyclothymia and unipolar Metabolized by kidney 5-7 days onset Blood levels correlate with efficacy
Lithium
Uses of mood stabilizers
Acute mania
Prevent relapses of mania in bipolar and schizoaffectice disorder
Potentiation of antidepressants in refractoy MDD
Potentiation of antipsychotics in schizophrenia
Alcohol abstinence
Treatment of impulsivity
Prior to starting lithium
Ecg Basic chemistries Thyroid CBC Pregnancy
Drawback of lithium
Narrow therapeutic range 0.6-1.2
Toxic >1.5 lethal >2.0
SE
Lithium SE
Toxic levels: AMS, coarse tremors, convulsions, death Fine tremor Nephrogenic DI GI disturbance Weight gain Sedation Thyroid enlarge plus hypothyroid Ecg Benign leukocytosis Epstein's anomaly in babies
Only mood stabilizer that decreases suicidality
Lithium
Don’t combine lithium with
Ibuprofen
Factors that affect Li+ levels
NSAID-increase level decrease clearance Aspirin Dehydration- increase Salt deprivation- increase Sweating- increase Impaired renal- increase Diuretics especially thiazides
Anticonvulsant
Treating mixed and rapid cycling bipolar
Less effective for depressive phase
Triennial neuralgia
Carbamazepine tegretol
Carbamazepine mechanism
Blocks Na channels inhibiting action potentials
Onset 5-7 days
Before starting carbamazepine
CBC LFT
Carbamazepine SE
GI and CNS (drowsiness, ataxia, sedation, confusion)
Stevens-Johnson
Leukopenia, hyponatremia, aplastic anemia, thrombocytopenia, agranulocytosis
Increase LFT
Teratogenic NTD
Auto induction p450
Carbamazepine toxicity
Confusion Stupor Motor restlessness Ataxia Tremor Nystagmus Twitching Vomiting
Valproic acid depakote depakene
Mixed episodes of bipolar and rapid cycling
Monitor LFTs and CBC
Check drug levels 3-5 days later
Anticonvulsant
Bipolar depression
Little efficacy for acute mania
Lamotrigine lamictal
Lamotrigine mechanism
Na channels that modulate glutamate and aspartate
SE lamotrigine
Dizziness Sedation Headaches Ataxia Steven Johnson 10% in first 4-6 weeks
Valproate and lamotrigine
Valproate increases lamotrigine levels
Lamotrigine decreases valproate levels
Better tolerated than carbamazepine
Less risk of rash and hepatic toxicity
Oxcarbazepine trileptal
Adjunctive to help anxiety and sleep
Little efficacy in bipolar
Gabapentin neurontin
GAD and fibromyalgia
Little efficacy for bipolar
Pregabalin lyrics
Helpful with anxiety
Tigabine gabitril
Impulse control disorder and anxiety
Weight loss
Hypochloremic nonanion gap metabolic acidosis and kidney stones
Cognitive slowing
Topiramate topamax
SE anticonvulsants
GI Weight gain Sedation Alopecia Pancreatitis Hepatotoxicity or benign increase aminotransferase Increase Ammonia Thrombocytopenia Teratogenic NTD
