Mood Stabilizers

Question 0

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

Answer 0

Lithium

Question 1

Uses of mood stabilizers

Answer 1

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

Question 2

Prior to starting lithium

Answer 2

Ecg
Basic chemistries 
Thyroid
CBC
Pregnancy

Question 3

Drawback of lithium

Answer 3

Narrow therapeutic range 0.6-1.2
Toxic >1.5 lethal >2.0
SE

Question 4

Lithium SE

Answer 4

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

Question 5

Only mood stabilizer that decreases suicidality

Answer 5

Lithium

Question 6

Don’t combine lithium with

Answer 6

Ibuprofen

Question 7

Factors that affect Li+ levels

Answer 7

NSAID-increase level decrease clearance 
Aspirin
Dehydration- increase
Salt deprivation- increase
Sweating- increase
Impaired renal- increase
Diuretics especially thiazides

Question 8

Anticonvulsant
Treating mixed and rapid cycling bipolar
Less effective for depressive phase
Triennial neuralgia

Answer 8

Carbamazepine tegretol

Question 9

Carbamazepine mechanism

Answer 9

Blocks Na channels inhibiting action potentials

Onset 5-7 days

Question 10

Before starting carbamazepine

Answer 10

CBC LFT

Question 11

Carbamazepine SE

Answer 11

GI and CNS (drowsiness, ataxia, sedation, confusion)
Stevens-Johnson
Leukopenia, hyponatremia, aplastic anemia, thrombocytopenia, agranulocytosis
Increase LFT
Teratogenic NTD
Auto induction p450

Question 12

Carbamazepine toxicity

Answer 12

Confusion
Stupor 
Motor restlessness
Ataxia
Tremor
Nystagmus
Twitching
Vomiting

Question 13

Valproic acid depakote depakene

Answer 13

Mixed episodes of bipolar and rapid cycling
Monitor LFTs and CBC
Check drug levels 3-5 days later

Question 14

Anticonvulsant
Bipolar depression
Little efficacy for acute mania

Answer 14

Lamotrigine lamictal

Question 15

Lamotrigine mechanism

Answer 15

Na channels that modulate glutamate and aspartate

Question 16

SE lamotrigine

Answer 16

Dizziness
Sedation
Headaches
Ataxia
Steven Johnson 10% in first 4-6 weeks

Question 17

Valproate and lamotrigine

Answer 17

Valproate increases lamotrigine levels

Lamotrigine decreases valproate levels

Question 18

Better tolerated than carbamazepine

Less risk of rash and hepatic toxicity

Answer 18

Oxcarbazepine trileptal

Question 19

Adjunctive to help anxiety and sleep

Little efficacy in bipolar

Answer 19

Gabapentin neurontin

Question 20

GAD and fibromyalgia

Little efficacy for bipolar

Answer 20

Pregabalin lyrics

Question 21

Helpful with anxiety

Answer 21

Tigabine gabitril

Question 22

Impulse control disorder and anxiety
Weight loss
Hypochloremic nonanion gap metabolic acidosis and kidney stones
Cognitive slowing

Answer 22

Topiramate topamax

Question 23

SE anticonvulsants

Answer 23

GI 
Weight gain
Sedation
Alopecia
Pancreatitis
Hepatotoxicity or benign increase aminotransferase
Increase Ammonia
Thrombocytopenia
Teratogenic NTD