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Psychiatry > Mood Stabilizers > Flashcards

Mood Stabilizers Flashcards

1
Q

How many hours after last dose should blood levels of Lithium be drawn?

A

12 hours (Trough)

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2
Q

What should Lithium levels be above for MAINTENANCE treatment of Bipolar Disorder

A

0.6-0.8 mEq/L

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3
Q

What labs should be done before starting a young male patient on Lithium?

A

TSH

BUN/Cr

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4
Q

What labs are done 1-2x per year for Lithium miantenance treatment?

A

Lithium Level
TSH
BUN/Creatinine

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5
Q

What worsens or improves tremors when using Lithium

A

Worsens: Caffeine
Improves: Propranolol

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6
Q

What mortality risk does Lithium decrease?

A

Suicide

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7
Q

How do we treat Lithium toxicity?

A

Dialysis

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8
Q

What level of lithium requires dialysis treatment?

A

> 4.0mEq/L

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9
Q

When should a lithium level be done to confirm therapeutic levels after starting?

A

5 days

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10
Q

What can increase risk of lithium toxicity?

A

Renal Impairment
Sodium Depletion
Dehydration

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11
Q

What congenital defect is associated with Depakote and when?

A

Neural Tube Defect (Spina Bifida): during 1st trimester of pregnancy

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12
Q

What lab tests should be done before starting a male patient on Depakote?

A

LFT

Platelets

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13
Q

What should be done when a patient on Lamotrigine needs to take Depakote?

A

Decrease Lamotrigine dose by half

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14
Q

What is a common SE of Depakote and how is it treated?

A

Tremors

Treat with Propranolol

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15
Q

Which population age is at the greatest risk of fatal hepatotoxicity with depakote?

A

<2 year old

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16
Q

Advantage of enteric coated Depakote compared to generic valproic acid

A

Less GI SE (N/V/D, GI discomfort)

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17
Q

Ironically, divalproex (depakote) is indicated as prophylaxis for this condition, which is also one of divalproex (depakote)’s
common side effects

A

Headache

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18
Q 
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
A

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

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19
Q

What risk does a patient face when they take aspirin while taking Depakote?

A

Thrombocytopenia

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20
Q

What happens in auto-induction with Carbamazepine

A

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

21
Q

What congenital defect does Carbamazepine raise a risk for?

A

Neural Tube Defects

During 1st trimester of prengancy

22
Q

Blackbox warning SE of Carbamazepine

A

Agranulocytosis

Aplastic Anemia

23
Q

What electrolyte abnormality may be seen in patients taking Carbamazepine?

A

Hyponatremia

24
Q

Which p450 enzyme is Carbamazepine an inducer of?

A

CYP 3A4

25
Q

What risk is associated with patients taking Carbamazepine with birth control?

A

Increased risk of prengancy

26
Q

What is Oxcarbamazepine (Trileptal)?

A

Similar to Carbamazepine with fewer SE

NOT FDA APPROVED for treatment of Bipolar Disorder

27
Q

What lab tests do patients on long term treatment with Depakote or Carbamazepine need?

A

Blood levels
Platelets/CBC
LFT

28
Q

What should be given to a woman on Carbamazepine who wants to become preganant?

A

Folate-> decreases risk of birth defects

29
Q

10% of patients who start taking Lamotrigine (Lamictal) develop what common SE?

A

Benign Rash

30
Q

What serious skin SE can patients on Lamotrigine (Lamictal) develop?

A

SJS

31
Q

What drug interaction can lead to increased levels of Lamictal?

A

Lamotrigine (Lamictal) +Depakote

Doubles Lamictal levels

32
Q

What drugs are FDA approved to treat bipolar depression in patients with bipolar disorder?

A 
Lamotrigine (Lamictal)
Quetiapine (Seroquel)
Lithium 
Olanzapine/Fluoxetine (Symbyax)
Latuda (Lurasidone)
33
Q

What drugs are FDA approved for use in maintenance treatment of bipolar disorder?

A 
Lamotrigine (Lamictal)
Lithium
Quetiapine (Seroquel)
Olanzapine (Zyprexa)
Aripiprazole (Abilify)
34
Q

What phase of bipolar disorder is Lamotrigine (Lamictal) NOT indicated to treat?

A

Acute Manic Episode

35
Q

What drugs are FDA indicated for treating acute manic episode in bipolar disorder?

A 
Lithium
Depakote
Carbamazepine ER
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Asenapine (Saphris)
36
Q

Which SE is not seen with Lamotrigine (Lamictal) that is seen with other mood stabilizers?

A

Weight Gain and Sedation

Seen with Lithium, Depakote, Quetiapine (Seroquel), Olanzapine (Zyprexa)

37
Q

MOA of Carbamazepine, Depakote, and Lamotrigine

A

Block Sodium Channels

38
Q

What is Olanzapine (Zyprexa) approved for treating

A

Acute Mania

Maintenance Treatment of Bipolar Disorder

39
Q

What SE is Olanzapine (Zyprexa) at highest risk for?

A

Weight Gain
Hyperlipidemia
Diabetes

40
Q

What is Ziprasidone (Geodo) used for?

A

Acute Mania

Manitenance Treatment of Bipolar Disorder

41
Q

How does Ziprasidone (Geodon) need to be taken?

A

Taken with food or >50% will not be absorbed in the GI tract

42
Q

What is unique about Aripiprazole (Abilifty)

A

Long half life (~75hrs)

2 weeks to reach steady state

43
Q

Which SGA acts like a FGA at high doses?

A

Risperidone (Risperdal) -> much higher rate of EPS SE

44
Q

How is Asenapine (Saphris) taken? Why?

A

Sublingually

If it is swallowed only 5% wil be bioavailable due to 1st pass through liver

45
Q

Which SGA cause least weight gain and least risk of metabolic syndrome?

A

Ziprasidone (Geodon)

Aripiprazole (Abilifty)

46
Q

When should Ziprasidone (Geodon) be avoided?

A

ECG with QTc >500ms

47
Q

Which SGA are FDA approved for treating Bipolar Depression

A

Quetiapine (Seroquel)
Latuda (Lurasidone)
Olanzapine (Zyprexa) + Fluoxetine (Prozac)

48
Q

Which SGA are available in long acting injectable form?

A

Aripiprazole (Abilify)
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Palliperidone (Invega)

Psychiatry (7 decks)

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