Mood stabilizers Flashcards
What are the 7 mood stabilizers?
- Lithium
- Carbamazepine
- Valproic acid
- Oxcarbazepine
- Lamotrigine
- Gabapentin
- Topiramate
What is the only mood stabilizer shown to decrease suicidality?
Lithium
What are uncommon uses for mood stabilizers (4)?
- Potentiation of antidepressants in pts with major depression refractory to monotherapy
- Potentiation of antipsychotics in pts w/ schiz
- Enhancement of abstinence in tx of alcoholism
- Tx of aggression and impulsivity (dementia, intoxication, mental retardation, personality disorders, general medical onditions)
What is the drug of choice in acute mania and prophylaxis for both manic and depressive episodes in BP and SAD?
lithium
What are blood levels useful for? (4)
lithium, VPA, carbamazapine, clozapine
Where is lithium metabolized?
kidney
What is the onset of action for lithium?
5-7 days
Why are blood levels important for lithium?
blood levels correlate with clinical efficacy
- should be checked after 5 days, and every 2-3 days until therapeutic
What is the major drawback of lithium?
high incidence of side effects and very narrow therapeutic index
What is the therapeutic range of lithium?
0.7 - 1.2
What are factors that can affect lithium levels? (6)
- NSAIDs (will lower)
- aspirin
- dehydration (will increase)
- salt deprivation (will increase)
- impaired renal function (will increase)
- diuretics
What causes hypothyroidism, nephrogenic diabetes insipidus,, fine tremor, sedation, ataxia, thirst, metallic taste, polyuria, edema, weight gain, benign leukocytosis?
lithium
What can toxic levels of lithium cause?
altered mental status, coarse tremors, convulsions, and death
What is the mechanism of action of carbamazepine?
blocking sodium channel and inhibiting action potential
What are some side effects of carbamazepine? (5 in classes)
- GI = nausea, vomiting, diarrhea
- CNS = sedation, lightheadedness, tremor, cognitive blunting
- Electrolyte abnormalities (hyponatremia)
- Anticholinergic side effects
- Rash (can progress to Steven-Johnson syndrome)
What causes Ebstein’s anomaly in babies?
Lithium
What can cause Steven-Johnson syndrome?
Carbamazepine, lamotrigine (Steven Johnson is a lame guy who likes carbs)
What else can carbamazepine be used for?
trigeminal neuralgia
What can carbamazepine cause when used during pregnancy?
neural tube defects
What are 2 serious adverse effect of carbamazepine?
- Blood dyscrasias
- aplastic anemia
- agranulocytosis
- thrombocytopenia - Hepatotoxicity
What can carbamazepine toxicity cause?
- confusion
- stupor
- motor restlessness
- ataxia
- tremor
- nystagmus
- twitching
- vomiting
Which drugs go through the P450 pathway?
- carbamazepine
What is the normal drug level of valproic acid?
50-150 micrograms/mL
What is used to bipolar depression?
Lamotrigine
Most common s/es of lamotrigine (4)
- Dizziness
- Sedation
- headaches
- ataxia
What are 3 adjunctive mood stabilizers?
- Oxcarbazepine
- Gabapentin
- Topiramate
Diff. b/w carbamazepine and oxcarbazepine?
Oxcarbazepine has much less potential for hematologic, dermatologic, and hepatotoxicity
What is gabapentin also used for?
GAD and social anxiety
What is a beneficial side effect of topiramate?
weight loss
What are other side effects of topiramate? (3)
- cognitive slowing (most limiting side effect)
- hypochloremic non-anion gap metabolic acidosis
- kidney stones
