Mood Stabilizers Flashcards
lithium
eskalith
MOA of lithium
unknown
indication of lithium
acute mania and maintenance of bipolar disorder (considered 1st line)
side effects of lithium
GI distress, weight gain, fine tremor, cognitive impairment
is lithium toxic or fatal in overdose?
it can be - n/v/d, corse tremor, ataxia, sludder speech, confusion, arrhythmia
long term side effects of lithium
kidney: concentrating defects, nephrogenic diabetes insipidus
hypothyroidism, goiter
cardiac arrhythmia due to sinus node dysfunction
are baseline labs needed before placing a patient on lithium?
CBC, BMP, EKG, TSH/T4, bHCG
do lithium levels need to be monitored?
YES, every 2-6 months along with TSH and kidney function
pregnancy category
D -> cardiac anomalies
valproate
depakene, depakote
MOA valproate
reason for therapeutic effect not understood
indication for valproate
actue mania and maintenance for BPD, schizoaffective d/o, schizophrenia, restrictive depressive d/o, impulse control d/o, borderline PD, behavioral disturbances associated with developmental disability
black box warnings for valproate
- hepatotoxicity - usually within the first 6 months, mostly
common side effects for valproate
GI upset, weight gain, sedation, tremor, hair loss
can valproate be combined with lithium?
YES
can valproate be combined with lamictal?
NO - SJS
baseline screening for valproate?
YES LFTs, CBC, platelet, bHCG
monitoring for valproate?
alproic acid levels, LFTs after 1 month then every 6-24 months
lamotrigine
lamictil
MOA of lamictil
blocks Na channels in the brain related to neuron firing which diminishes the buildup of glutamate in the CSF, modest inhibition of serotonin reuptake
indications for lamictil
maintenance of BPD (NOT FDA approved for acute)
what happens if you increase the dose of lamictil too quickly?
SJS
side effects of lamictil
mild - dizzy, HA, blurred vision, nausea, back/joint pain, cognitive impairment often self reported
labs for lamictil?
NOPE, no baseline or monitoring
How is lithium secreted?
Kidney
Onset of action of lithium
5-7 days
Major drawback of lithium
High incidence of side effects and a very narrow therapeutic index
Carbamazepine
Tegretol
What type of drug is Tegretol?
Anticonvulsant
Use of Tegretol
Mixed episodes and rapid cycling bipolar disorder
Also used in management of trigrminal neuralgia
MOA of Tegretol
Blocks Na channels and inhibits action potentials
Onset of Tegretol
5-7 days
Side effects of Tegretol
Rash, drowsiness, ataxia, slurred speech, leukopenia, hyponatremia, aplastic anemia, agranulocytosis and elevation of liver enzymes
Can Tegretol be given in pregnancy?
No! It’s teratogenic
What labs should be monitored if a patient is on Tegretol?
CBC and LFTs
