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Psychiatry > Mood Stabilizers > Flashcards

Mood Stabilizers Flashcards

1
Q

Mood Stabilizer

  • Rx for Acute Mania
  • Prophylaxis for both Manic and Depressive episodes in Bipolar and Schizoaffective disorders
  • Rx for Cyclothymic disorder
  • Rx for Unipolar disorder
A

Lithium

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2
Q

Rx - Rx interaction

  • NSAIDs
  • Aspirin
  • Thiazide diuretics
  • Dehydration
  • Salt deprivation
  • Sweating (salt loss)
  • Impaired Renal Function
A

Rx factors that incease Li+ levels

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3
Q

Cardiac anomaly a/w Lithium

A

Ebstein’s anomaly

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4
Q

Intoxication

  • Altered mental status, Coarse tremors, Convulsions, Delirium, Coma, and Death
  • Nephrogenic Diabetes insipidus
  • GI disturbance
  • Weight gain
  • Sedation
  • Thyroid enlargement, Hypothyroidism
  • ECG changes
  • Benign leukocytosis
A

Li Toxicity

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5
Q

Therapeutic range of Lithium

A

Therapeutic range: 0.6 - 1.2

Toxic: > 1.5

Potentially lethal: > 2.0

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6
Q

Anticonvulsants

  • Rx for Mania w/ mixed features and Rapid-cycling Bipolar Disorder
  • Blocks Sodium channels and Inhibiting Action potentials
  • Obtain CBC and LFTs prior to initializing
A

Carbamazepine (Tergretol)

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7
Q

Anticonvulsant

  • SE:
    • GI and CNS (drowsiness, ataxia, sedation, confusion)
    • Steven-Johnson Syndrome
    • Leukopenia, Hyponatremia, Aplastic anemia, Thrombocytopenia, and Agranulocytosis
    • Elevation of Liver Enzymes
    • Teratogenic effects (Neural tube defects)
A

Carbamazepine (Tegretol)

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8
Q

Intoxication

  • Confusion
  • Stupor
  • Motor restlessness
  • Ataxia
  • Tremor
  • Nystagmus
  • Twitching
  • Vomiting
A

Carbamazepine (Tegretol)

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9
Q

Anticonvulsant

  • Rx for Acute Mania, Mania w/ mixed features, and Rapid cycling
  • Blocks sodium channels and Increases GABA concentrations in the Brain
  • Monitor LFTs and CBC is necessary
A

Valproic acid (Depakote and Depakene)

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10
Q

Anticonvulsant

  • Rx for Bipolar depression
  • Little efficacy for Acute mania or prevention of Mania
  • SE:
    • Dizziness
    • Sedation
    • HA
    • Ataxia
    • Stevens-Johnson syndrome
A

Lamotrigine (Lamictal)

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11
Q

Anticonvulsant

  • As effective in Mood disorders as Carbamazepine but better tolerated
  • Less risk of Rash and Hepatic Toxicity
  • Monitor Sodium lvls for Hyponatremia
A

Oxcarbazepine (Trileptal)

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12
Q

Anticonvulsant

  • Often used adjunctively to help w/ Anxiety, Sleep, Neuropathic pain
  • Little efficacy in Bipolar disorder
A

Gabapentin (Neurontin)

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13
Q

Anticonvulsant

  • Used in Generalized Anxiety Disorder (GAD) (second-line) and Fibromyalgia
  • Little efficacy in Bipolar disorder
A

Pregabalin (Lyrica)

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14
Q

Anticonvulsant

  • May be helpful with Impulse Control Disorder
  • Beneficial SE of Weight Loss
  • SE:
    • Hypochloremic
    • Metabolic acidosis
    • Kidney stones
    • Cognitive slowing
A

Topiramate (Topamax)

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15
Q

Benzodiazepines that are not metabolized by the Liver?

A

(LOT)

Lorazepam

Oxazepam

Temazepam

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16
Q

(3) Types of Anxiolytics / Hypnotics?

A

Benzodiazepines

Barbiturates

Buspirone

17
Q

Class of Rx

  • Potentiating Gamma-aminobutyric acid (GABA)
  • Reduce Anxiety and useful for Akathisia
  • Physically dependent forming
  • SE:
    • Drowsiness
    • Impairment of Intellectual function
    • Reduced motor coordination (careful in elderly)
    • Anterograde amnesia
    • Life-threatening withdrawal and Seizures
    • Respiratory depression in overdose
A

Benzodiazepines

18
Q

Long Acting Benzo (1/2 > 20 hrs)

  • Rapid onset
  • Rx for Detoxification from EtOH
  • Rx for Sedative-hypnotic-anxiolytics
  • Rx for Seizures
  • Rx for Muscle spasms
  • A/w Euphoria
A

Diazepam (Valium)

19
Q

Long Acting Benzo (1/2 > 20 hrs)

  • Rx for Anxiety, including Panic Attacks
  • Avoid w/ Renal dysfunction
  • One or Twice daily dosing
A

Clonazepam (Klonopin)

20
Q

Intermediate Benzo (1/2 ~6 - 20 hrs)

  • Rx for Anxiety, including Panic Attacks
  • Shorter onset of Action –>
    • Euphoria
    • High abuse potential
A

Alprazolam (Xanx)

21
Q

Intermediate Benzo (1/2 ~6-20 hrs)

  • Rx for Panic attacks
  • Rx for EtOH, Sedative-hypnotic-anxiolytic detoxification, and Agitation
  • Not metabolized by the Liver
A

Lorazepam (Ativan)

22
Q

Intermediate Benzo (1/2 ~ 6-20 hrs)

  • Alcohol and Sedative-hypnotic-anxyiolytic detocification
  • Not metabolized by Liver
A

Oxazepam (Serax)

23
Q

Intermediate Benzo (1/2 ~6-20 hrs)

  • Because of dependence, decreasingly used for Tx of Insomnia
  • Not metabolized by Liver
A

Temazepam (Restoril)

24
Q

Short Benzo (1/2 < 6 hrs)

  • Treatment for Insomnia
  • Risk of Anterograde amnesia and Sleep-related activities (eating, driving, etc.)
A

Triazolam (Halcion)

25
Q

Short Benzo (1/2 < 6 hrs)

  • Very short Half-life
  • Primarily used in Medical and Surgical settings
A

Midazolam (Versed)

26
Q

Non-Benzo Hypnotics

  • Binds to Omega-1 receptor on GABA-A receptor –> responsible for sedation
  • Rx for short-term Rx for Insomnia
  • Less tolerance / dependence occurs
  • SE:
    • Sedation
    • Dry mouth
    • Constipation
    • Urinary retention
    • Blurry vision
A

Zolpidem (Ambien)

Zaleplon (Sonata)

Eszopiclone (Lunesta)

27
Q

Non-Benzo Hypnotics

  • Antihistamine
  • SE:
    • Sedation
    • Dry mouth
    • Constipation
    • Urinary retention
    • Blurry vision
A

Diphenhydramine (Benadryl)

28
Q

Non-Benzo Hypnotics

  • Selective Melatonin MT1 and MT2 agonist
  • No tolerance
  • No dependence
A

Ramelteon (Rozerem)

29
Q

Non-Benzo Anxiolytics

  • Partial agonist at 5HT-1A receptor
  • Slower onset then Benzos
  • Not as effective as SSRI for GAD
  • Does not potentiate the CNS depression of EtOH
  • Low potential for abuse
A

Buspirone (BuSpar)

30
Q

Non-Benzo Anxiolytics

  • Antihistamine
  • Rx for pts who want a Quick-acting, short-term medication but cannot take Benzos for whatever reason
  • SE:
    • Sedation
    • Dry mouth
    • Constipation
    • Urinary Retention
    • Blurry vision
A

Hydroxyzine (Atarax)

31
Q

Non-Benzo Anxiolytics

  • Beta-blocker
  • Rx for Akathisia (SE of antipsychotics)
  • Rx for Autonomic effects of Panic attacks or Social phobia (performance anxiety) such as Palpitations, Sweating, and Tachy
A

Propranolol

Psychiatry (12 decks)

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