Mood Stabilizers Flashcards
Drug of choice in acute mania
Lithium
*also used for maintenance of both manic and depressive episodes in bipolar and schizoaffective disorder. Also used in cyclothymia and unipolar depression
Prior to starting lithium what tests should be ordered? (5)
- EKG
- BMP - for kidney function (Li cleared renally!)
- Thyroid function tests
- CBC
- Pregnancy test
*need to regularly monitor blood levels of Li, thyroid function, and kidney function, monitor carefully if renal dysfunction
When should blood levels of lithium be checked (first two times after starting)?
1st after 5 days, then q2-3 days until therapeutic
What is a therapeutic range for lithium
0.6 to 1.2
At what level does lithium become toxic? Lethal?
> 1.5; lethal above 2
What are 3 signs of Li toxicity?
- Altered mental status
- coarse tremors
- Convulsions
Eventually death if not treated
What are four factors that can cause Li levels to rise?
- Renal impairment
- Dehydration
- Sweating (salt loss)
- Salt deprivation
What common drug causes Li levels to decrease? What other two classes of drugs affect Li levels?
NSAIDs decrease levels
*Diuretics (thiazides esp) and ASA both alter levels as well
What are 5 side effects of Li?
- Nephrogenic diabetes insipidus
- Weight gain
- Thyroid enlargement/ hypothyroidism
- EKG changes
- Benign leukocytosis
What two conditions is carbamazepine useful in treating?
Mixed episodes and rapid cycling bipolar d/o
- less effective for the depressed phase
- also used for treatment of trigeminal neuralgia
What two tests must be ordered and monitored in patients taking carbamazepine?
- CBC
2. LFTs
What are th most common side effects of carbamazepine?
GI and CNS (drowsiness, ataxia, sedation, confusion)
What are 6 serious side effects that can be seen with carbamazepine?
- SJS
- Agranulocytosis (so leukopenia)
- aplastic anemia
- hyponatremia
- Elevation of liver enzymes - hepatitis
- thrombocytopenia
What is a teratogenic effect that can be seen with carbamazepine?
Neural tube defects
What effects does carbamazepine have on CYP enzymes?
Is an inducer - even of its own metabolism, so may require increasing doses to achieve therapeutic range
What are symptoms of carbamazepine toxicity?
- nystagmus
- tremor
- confusion
- ataxia
- confusion
- vomiting
MOA of carbamazepine
Na channel blocker - inhibits APs
When are valproic acid levels checked after initiation? Therapeutic levels are?
After 3-5 days; levels are 50-150 microgram/mL
*used for mixed episodes and rapid cycling, like carbamazepine
What two tests to monitor with valproic acid?
LFTs and CBC
what is lamotrigine used for? What is it not as helpful for?
Used for bipolar depression, not as useful for acute mania or prevention of acute mania
What is most serious side effect of lamotrigine?
SJS - most likely in first 4-6 weeks, start low dose and increase slowly
*other side effects include dizziness, sedation, HA, ataxia
What relationship do valproic acid and lamotrigine have on each other if given at same time?
Valproate will increase lamotrigine levels and lamotrigine will decrease valproic acid levels
What drug is as effective as carbamazepine in mood disorder, but is better tolerated and has less risk of rash and hepatic toxicity?
Oxcarbazepine (trileptal)
What drug is useful for impulse control disorder and anxiety?
Topiramate
*but can cause hypochloremic, non-anion gap metabolic acidosis and kidney stones
