Mood Stabilizers Flashcards
How many hours after last dose should blood levels of Lithium be drawn?
12 hours (Trough)
What should Lithium levels be above for MAINTENANCE treatment of Bipolar Disorder
0.6-0.8 mEq/L
What labs should be done before starting a young male patient on Lithium?
TSH
BUN/Cr
What labs are done 1-2x per year for Lithium miantenance treatment?
Lithium Level
TSH
BUN/Creatinine
What worsens or improves tremors when using Lithium
Worsens: Caffeine
Improves: Propranolol
What mortality risk does Lithium decrease?
Suicide
How do we treat Lithium toxicity?
Dialysis
What level of lithium requires dialysis treatment?
> 4.0mEq/L
When should a lithium level be done to confirm therapeutic levels after starting?
5 days
What can increase risk of lithium toxicity?
Renal Impairment
Sodium Depletion
Dehydration
What congenital defect is associated with Depakote and when?
Neural Tube Defect (Spina Bifida): during 1st trimester of pregnancy
What lab tests should be done before starting a male patient on Depakote?
LFT
Platelets
What should be done when a patient on Lamotrigine needs to take Depakote?
Decrease Lamotrigine dose by half
What is a common SE of Depakote and how is it treated?
Tremors
Treat with Propranolol
Which population age is at the greatest risk of fatal hepatotoxicity with depakote?
<2 year old
Advantage of enteric coated Depakote compared to generic valproic acid
Less GI SE (N/V/D, GI discomfort)
Ironically, divalproex (depakote) is indicated as prophylaxis for this condition, which is also one of divalproex (depakote)’s
common side effects
Headache
For divalproex (depakote), while the trough level of the Immediate Release (IR) should be drawn 12 hrs after the last dose, the trough level of Extended Release (ER) should be drawn at this time
18 hours after the last dose
If IR -> Last dose at 10pm -> draw blood at 10am
If ER- > Last dose at 10pm -> drw blood at 4pm
What risk does a patient face when they take aspirin while taking Depakote?
Thrombocytopenia
What happens in auto-induction with Carbamazepine
Over the first few weeks of taking carbamazepine (tegretol) its t1/2 will decease to less than 50%of
its initial t1/2 due to this
What congenital defect does Carbamazepine raise a risk for?
Neural Tube Defects
During 1st trimester of prengancy
Blackbox warning SE of Carbamazepine
Agranulocytosis
Aplastic Anemia
What electrolyte abnormality may be seen in patients taking Carbamazepine?
Hyponatremia
Which p450 enzyme is Carbamazepine an inducer of?
CYP 3A4
What risk is associated with patients taking Carbamazepine with birth control?
Increased risk of prengancy
What is Oxcarbamazepine (Trileptal)?
Similar to Carbamazepine with fewer SE
NOT FDA APPROVED for treatment of Bipolar Disorder
What lab tests do patients on long term treatment with Depakote or Carbamazepine need?
Blood levels
Platelets/CBC
LFT
What should be given to a woman on Carbamazepine who wants to become preganant?
Folate-> decreases risk of birth defects
10% of patients who start taking Lamotrigine (Lamictal) develop what common SE?
Benign Rash
What serious skin SE can patients on Lamotrigine (Lamictal) develop?
SJS
What drug interaction can lead to increased levels of Lamictal?
Lamotrigine (Lamictal) +Depakote
Doubles Lamictal levels
What drugs are FDA approved to treat bipolar depression in patients with bipolar disorder?
Lamotrigine (Lamictal) Quetiapine (Seroquel) Lithium Olanzapine/Fluoxetine (Symbyax) Latuda (Lurasidone)
What drugs are FDA approved for use in maintenance treatment of bipolar disorder?
Lamotrigine (Lamictal) Lithium Quetiapine (Seroquel) Olanzapine (Zyprexa) Aripiprazole (Abilify)
What phase of bipolar disorder is Lamotrigine (Lamictal) NOT indicated to treat?
Acute Manic Episode
What drugs are FDA indicated for treating acute manic episode in bipolar disorder?
Lithium Depakote Carbamazepine ER Quetiapine (Seroquel) Ziprasidone (Geodon) Asenapine (Saphris)
Which SE is not seen with Lamotrigine (Lamictal) that is seen with other mood stabilizers?
Weight Gain and Sedation
Seen with Lithium, Depakote, Quetiapine (Seroquel), Olanzapine (Zyprexa)
MOA of Carbamazepine, Depakote, and Lamotrigine
Block Sodium Channels
What is Olanzapine (Zyprexa) approved for treating
Acute Mania
Maintenance Treatment of Bipolar Disorder
What SE is Olanzapine (Zyprexa) at highest risk for?
Weight Gain
Hyperlipidemia
Diabetes
What is Ziprasidone (Geodo) used for?
Acute Mania
Manitenance Treatment of Bipolar Disorder
How does Ziprasidone (Geodon) need to be taken?
Taken with food or >50% will not be absorbed in the GI tract
What is unique about Aripiprazole (Abilifty)
Long half life (~75hrs)
2 weeks to reach steady state
Which SGA acts like a FGA at high doses?
Risperidone (Risperdal) -> much higher rate of EPS SE
How is Asenapine (Saphris) taken? Why?
Sublingually
If it is swallowed only 5% wil be bioavailable due to 1st pass through liver
Which SGA cause least weight gain and least risk of metabolic syndrome?
Ziprasidone (Geodon)
Aripiprazole (Abilifty)
When should Ziprasidone (Geodon) be avoided?
ECG with QTc >500ms
Which SGA are FDA approved for treating Bipolar Depression
Quetiapine (Seroquel)
Latuda (Lurasidone)
Olanzapine (Zyprexa) + Fluoxetine (Prozac)
Which SGA are available in long acting injectable form?
Aripiprazole (Abilify)
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Palliperidone (Invega)
