Mood Stabilizers Flashcards
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
Lithium
Rx - Rx interaction
- NSAIDs
- Aspirin
- Thiazide diuretics
- Dehydration
- Salt deprivation
- Sweating (salt loss)
- Impaired Renal Function
Rx factors that incease Li+ levels
Cardiac anomaly a/w Lithium
Ebstein’s anomaly
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
Li Toxicity
Therapeutic range of Lithium
Therapeutic range: 0.6 - 1.2
Toxic: > 1.5
Potentially lethal: > 2.0
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
Carbamazepine (Tergretol)
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)
Carbamazepine (Tegretol)
Intoxication
- Confusion
- Stupor
- Motor restlessness
- Ataxia
- Tremor
- Nystagmus
- Twitching
- Vomiting
Carbamazepine (Tegretol)
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
Valproic acid (Depakote and Depakene)
Anticonvulsant
- Rx for Bipolar depression
- Little efficacy for Acute mania or prevention of Mania
- SE:
- Dizziness
- Sedation
- HA
- Ataxia
- Stevens-Johnson syndrome
Lamotrigine (Lamictal)
Anticonvulsant
- As effective in Mood disorders as Carbamazepine but better tolerated
- Less risk of Rash and Hepatic Toxicity
- Monitor Sodium lvls for Hyponatremia
Oxcarbazepine (Trileptal)
Anticonvulsant
- Often used adjunctively to help w/ Anxiety, Sleep, Neuropathic pain
- Little efficacy in Bipolar disorder
Gabapentin (Neurontin)
Anticonvulsant
- Used in Generalized Anxiety Disorder (GAD) (second-line) and Fibromyalgia
- Little efficacy in Bipolar disorder
Pregabalin (Lyrica)
Anticonvulsant
- May be helpful with Impulse Control Disorder
- Beneficial SE of Weight Loss
- SE:
- Hypochloremic
- Metabolic acidosis
- Kidney stones
- Cognitive slowing
Topiramate (Topamax)
Benzodiazepines that are not metabolized by the Liver?
(LOT)
Lorazepam
Oxazepam
Temazepam
(3) Types of Anxiolytics / Hypnotics?
Benzodiazepines
Barbiturates
Buspirone
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
Benzodiazepines
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
Diazepam (Valium)
Long Acting Benzo (1/2 > 20 hrs)
- Rx for Anxiety, including Panic Attacks
- Avoid w/ Renal dysfunction
- One or Twice daily dosing
Clonazepam (Klonopin)
Intermediate Benzo (1/2 ~6 - 20 hrs)
- Rx for Anxiety, including Panic Attacks
- Shorter onset of Action –>
- Euphoria
- High abuse potential
Alprazolam (Xanx)
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
Lorazepam (Ativan)
Intermediate Benzo (1/2 ~ 6-20 hrs)
- Alcohol and Sedative-hypnotic-anxyiolytic detocification
- Not metabolized by Liver
Oxazepam (Serax)
Intermediate Benzo (1/2 ~6-20 hrs)
- Because of dependence, decreasingly used for Tx of Insomnia
- Not metabolized by Liver
Temazepam (Restoril)
Short Benzo (1/2 < 6 hrs)
- Treatment for Insomnia
- Risk of Anterograde amnesia and Sleep-related activities (eating, driving, etc.)
Triazolam (Halcion)
Short Benzo (1/2 < 6 hrs)
- Very short Half-life
- Primarily used in Medical and Surgical settings
Midazolam (Versed)
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
Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)
Non-Benzo Hypnotics
- Antihistamine
- SE:
- Sedation
- Dry mouth
- Constipation
- Urinary retention
- Blurry vision
Diphenhydramine (Benadryl)
Non-Benzo Hypnotics
- Selective Melatonin MT1 and MT2 agonist
- No tolerance
- No dependence
Ramelteon (Rozerem)
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
Buspirone (BuSpar)
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
Hydroxyzine (Atarax)
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
Propranolol
