Mood Stabilizers

Question 1

Anti-epileptics

Atypical

Answer 1

LIthium is on its own

Divalproex, lamotrgine

Aripiprazole, olanzapine, quetiapine

Question 2

Which part of BPD do modd stabilizers tx?

Answer 2

Both

Question 3

Ideal mood stabilizer

Answer 3

Tx of mania and bipolar depression

Both acute and prophylaxis

Question 4

Tx of bipolar depression vs. MD

Answer 4

Independent although fluoxetine comes can come with one

Antidepressants should NOT be used an monotherapy because of mood switching

Question 5

Lithium indications

Answer 5

Acute manic - first line but slower
Acute of bipolar depression - first line
Maintenance - first line but some issues

Question 6

Lithium MOA

Answer 6

Not well understood but affects secondary messenger systems

Question 7

Lithium absorption, elimination, distribution

Answer 7

Passive and complete in GI

Mostly by kidney and most gets reabsorbed in the proximal tubule

No plasma protein binding so small volume of distributuioon

T1/2 is about 24 hours so it takes a while to reach a new peak after adjusting

Question 8

Lithium dosage

Answer 8

Available in extended release of immediate

Question 9

Signs and symptoms of acute toxicity of lithium

Answer 9

Early -N/V sedation
Delayed - CNS
Late - renal failure and rigidity

Toxic is 2-2.5

Higher may be needed for tx of acute manic episodes vs. maintenance and depression

Question 10

Drug/disorder lithium interactions

Answer 10

Decreased renal function
Hyponatermia - low NA concentration stimulates renal Li reabsorption (because Na and Li compete)
Diuretics/NSAIDS - decrease lithium clearance

Question 11

Adverse effects of lithium

Answer 11

CNS - weight gain, tremor, sedation

Renal - neprhogenic diabetes insipidus and nephropathy

Question 12

Neprhogenic diabetes insipidus

Answer 12

Li enters collecting tubule epithelial cells which decreases expression of water channel aquaporin 2

Question 13

Divalproex is

Answer 13

1:1 valproic acid and its sodium salt

Question 14

When to use Dival/valproic

Lamo

Answer 14

Dival - second line for acute main and acute bipolar depression…first for maintenance

Lamo - 1st for acute tx of bipolar depression and second for maintence…NOT for manic

Question 15

Divalproex and lamotrigine differences

Answer 15

Dival - less nausea…DONT use in women of child bearing age

Lamo - less sedating but need titration

Question 16

Which is most effective, lithium or valproic acid?

Answer 16

Lithium

Question 17

Mechs of valproic and lamotrigine

Answer 17

Valp - Na, Ca blocker and increased GABA

Lamo - Na and Ca blocker

Question 18

MOA of increwased GABA

Answer 18

Increased GABA means inhibitory input…Na channel block slows/inhiits axonal condcution…block of presynaptic Ca channels decrease synaptic transmission particularly through glutamate release

Question 19

Forms of aripiprazole, olanzapine, quetiapine

Answer 19

aripiprazole - oral, disintigrating, injection

Olan - same

Que - oral

Question 20

only FDA atypical for acute bipolar depression

Answer 20

Quetiapine

Question 21

Uses of each atypical

Answer 21

Aripip - first line for manic…NOT for bipolar depression…second for maintence

Olan - first for manic…second for bipolar depression…second for maintence

Quetia - First line for acute tx of manic, bipolar depression and maintenance

Question 22

Advantage of atypicals

Answer 22

Quicker acting

Question 23

LEast sedating and least metabolic effects/weight gaine

Answer 23

Aripiprazole least sedating

Olanzapine most…quetiapine, then aripiprazole

Question 24

Issues with pregnancy of

Lithium
Valproic
Lamo
Atypicals

Answer 24

Fetal cardiac valve

Neural tube/IQ

Cleft palate

Withdrawl

Question 25

Which are 1st line for acute tx of manic

Answer 25

Lithium, all atypicals

Question 26

WHich are 1st line for acute bipolar depression

Answer 26

Lithium, lamotrigine, quetiapine

Question 27

Which are first line ofr maintenance

Answer 27

Lithium, divalproex, quetiapine