Mood Stabilizers Flashcards
Anti-epileptics
Atypical
LIthium is on its own
Divalproex, lamotrgine
Aripiprazole, olanzapine, quetiapine
Which part of BPD do modd stabilizers tx?
Both
Ideal mood stabilizer
Tx of mania and bipolar depression
Both acute and prophylaxis
Tx of bipolar depression vs. MD
Independent although fluoxetine comes can come with one
Antidepressants should NOT be used an monotherapy because of mood switching
Lithium indications
Acute manic - first line but slower
Acute of bipolar depression - first line
Maintenance - first line but some issues
Lithium MOA
Not well understood but affects secondary messenger systems
Lithium absorption, elimination, distribution
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
Lithium dosage
Available in extended release of immediate
Signs and symptoms of acute toxicity of lithium
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
Drug/disorder lithium interactions
Decreased renal function
Hyponatermia - low NA concentration stimulates renal Li reabsorption (because Na and Li compete)
Diuretics/NSAIDS - decrease lithium clearance
Adverse effects of lithium
CNS - weight gain, tremor, sedation
Renal - neprhogenic diabetes insipidus and nephropathy
Neprhogenic diabetes insipidus
Li enters collecting tubule epithelial cells which decreases expression of water channel aquaporin 2
Divalproex is
1:1 valproic acid and its sodium salt
When to use Dival/valproic
Lamo
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
Divalproex and lamotrigine differences
Dival - less nausea…DONT use in women of child bearing age
Lamo - less sedating but need titration
Which is most effective, lithium or valproic acid?
Lithium
Mechs of valproic and lamotrigine
Valp - Na, Ca blocker and increased GABA
Lamo - Na and Ca blocker
MOA of increwased GABA
Increased GABA means inhibitory input…Na channel block slows/inhiits axonal condcution…block of presynaptic Ca channels decrease synaptic transmission particularly through glutamate release
Forms of aripiprazole, olanzapine, quetiapine
aripiprazole - oral, disintigrating, injection
Olan - same
Que - oral
only FDA atypical for acute bipolar depression
Quetiapine
Uses of each atypical
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
Advantage of atypicals
Quicker acting
LEast sedating and least metabolic effects/weight gaine
Aripiprazole least sedating
Olanzapine most…quetiapine, then aripiprazole
Issues with pregnancy of
Lithium
Valproic
Lamo
Atypicals
Fetal cardiac valve
Neural tube/IQ
Cleft palate
Withdrawl
Which are 1st line for acute tx of manic
Lithium, all atypicals
WHich are 1st line for acute bipolar depression
Lithium, lamotrigine, quetiapine
Which are first line ofr maintenance
Lithium, divalproex, quetiapine
