Mood Stabilizers Flashcards
Blood levels should be drawn about this many hours after the last dose of lithium
12 hours (Trough)
For maintenance treatment of Bipolar disorder, lithium levels should generally be above this
0.6-0.8 mEq/L
Before starting a young male patient on lithium, labs that should routinely be done are these
TSH & BUN/creatinine
In lithium maintenance treatment, ideally these labs are done 1-2 times per year
lithium level, TSH, BUN/creatinine
This lithium side effect can be worsened by caffeine or improved with propranolol treatment
tremor (resting or postural)
Unlike any antidepressant or mood stabilizer, Lithium treatment decreases patient’s mortality risk from this
suicide
Lithium toxicity with a lithium level greater than 4.0 mEq/L is treated with this
dialysis
To confirm therapeutic levels after starting lithium or increasing the dose, a lithium level should be done after this number of days
5 days
For patients taking lithium, renal impairment, sodium depletion, or dehydration all increase the risk of this
lithium toxicity
Divalproex Sodium (Depakote) exposure during the first trimester of pregnancy increases the risk this serious congenital anomaly
neural tube defect (spina bifida)
Before starting a male patient on Divalproex Sodium (Depakote), these two lab tests should be done
LFT’s & platelets
If Divalproex Sodium (Depakote) is added to the medication regimen of a patient who is taking Lamotrigine (Lamictal) this should be done.
decrease Lamotrigine dose by half
Propranolol 2-3x’s per day may be used to treat this common side effect of divalproex (depakote)
Tremor
The age range of patients most at risk for divalproex’s (depakote) side effect of serious, possibly fatal, hepatoxicity is this
under 2 years old
Patients on the generic form of valproic acid (depakene) are at greater risk of developing this side effect than those on the enteric coated divalproex (depakote)
GI side effects (N/V/D, GI discomfort)
Ironically, divalproex (depakote) is indicated as prophylaxis for this condition, which is also one of divalproex (depakote’s) common side effects
Headache (indicated for migraine prophylaxis)
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
18 hour after the last dose Examples: - If IR-last dose 10pm, blood draw 10am - If ER-last dose 10pm, blood draw 4 pm
For a patient taking Divalproex Sodium (Depakote), taking aspirin increases the risk of this
decreased platelets (Thrombocytopenia)
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
auto-induction
Exposure of the fetus to carbamazepine during the 1st trimester of pregnancy leads to an unacceptable risk of this
neural tube defect
Carbamazepine (tegretol) has a black box warning for these two rare (~1/100,000 = 0.001%) but serious side effects on the hematopoietic system
agranulocytosis & aplastic anemia
This electrolyte may be abnormally low in patients who are taking carbamazepine (tegretol)
sodium
Carbamazepine (Tegretol) is both a substrate & an inducer of this cytochrome p450 enzyme system which makes up ~55% of the cytochrome p450 enzymes
CYP 3A4
Carbamazepine (tegretol)’s drug-drug interaction with hormonal birth control increases the risk of this
Pregnancy
Closely related structurally to carbamazepine (tegretol), this medication has far fewer side effects but is not FDA approved for treatment of bipolar disorder
oxcarbamazepine (trileptal)
Patients who are getting long term treatment with divalproex (depakote) or carbamazepine (tegretol) need to have regular labs done to check their medication blood levels, platelets/blood count, and this
liver function test
To decrease the risk of birth defects, a woman on carbemazepine (tegretol) who desires to become pregnant should also take this medication
Folate
Patients who start taking lamotrigine (lamictal) have a this % risk of developing a benign rash
10%
While on Lamotrigine, the side effect of a benign rash is relatively common, the risk of a severe rash is about 0.3%, and the risk of this is about 0.02-0.1%
Steven’s Johnson Syndrome
The drug-drug interaction between lamotrigine (lamictal) & divalproex sodium (depakote) results in lamictal’s blood level doing this
Increasing (doubles)
Lamotrigine (lamictal), quetiapine (seroquel), lithium, olanzapine/ fluoxetine (symbyax), & latuda (lurasidone) all have this in common regarding their usage in the treatment of pts with bipolar disorder
FDA indication to treats bipolar depression
Lamotrigine (lamictal), lithium, quetiapine (seroquel), olanzapine (zyprexa) & aripiprazole (abilify) all have this in common regarding their usage in treatment of pts with bipolar disorder
FDA indication for use in maintenance treatment of bipolar disorder
Lithium, divalproex (depakote), carbamazepine ER (tegretol ER) quetiapine (seroquel), ziprasidone (geodon), & asenapine (saphris) are FDA indicated to treat this phase of bipolar disorder but lamotrigine (lamictal) is not
an acute manic episode
Lithium, divalproex (depakote), carbamazepine ER (tegretol ER) quetiapine (seroquel), ziprasidone (geodon), & asenapine (saphris) are FDA indicated to treat the active phase of bipolar disorder but this drug is NOT
lamotrigine (lamictal)
Lithium, divalproex (depakote), quetiapine (seroquel), & olanzapine (zyprexa) with regard to these two common side effects are NOT side effects of lamotrigine (lamictal)
weight gain and sedation
The common mechanism of action for the mood stabilizers carbamazepine (tegretol), divalproex (depakote), and lamotrigine (lamictal) is blocking these
Sodium channels
This SGA has FDA indication to treat acute mania or for maintenance treatment of bipolar disorder, but of all the SGA’s it has the highest risk for weight gain, elevated lipids, and diabetes
olanzapine (zyprexa)
This SGA has FDA indication to treat acute mania or for maintenance treatment of bipolar disorder, but must be taken with food or > 50% will not be absorbed in the digestive tract
ziprasidone (geodon)
While this SGA has FDA indication to treat acute mania or for maintenance treatment of bipolar disorder, it has a particularly long half life of ~75 hours and takes nearly 2 weeks to reach steady state
aripiprazole (abilify)
This SGA has FDA indication to treat acute mania or for maintenance treatment of bipolar disorder, but at high doses (> 6 mg) it acts more like a FGA and has a much higher rate of EPS side effects
risperidone (risperdal)
This SGA has FDA indication to treat acute mania & must be taken sublingually because if it is swallowed only ~5% will be bioavailable due to 1st pass liver metabolism
asenapine (saphris)
These 2 SGA’s, in addition to being FDA indicated to treat acute mania or for maintenance treatment of bipolar disorder, are the least likely of the SGA’s to cause weight gain or metabolic syndrome
ziprasidone (geodon) & aripiprazole (abilify)
This SGA is FDA indicated to treat acute mania or for maintenance treatment of bipolar disorder, but should not be used in patient’s with ECG’s that show an QTc > 500 milliseconds
ziprasidone (geodon)
These three SGA’s are useful and FDA indicated for treating bipolar depression; two by themselves, the other in combination with fluoxetine (prozac)
quetiapine (seroquel), latuda (lurasidone) & olanzapine (zyprexa)
Risperidone (risperdal consta), paliperidone (invenga sustenna), and these 2 SGA’s are available in a long acting injectable form
aripiprazole (abilify maintena) & olanzapine (zyprexa relprevv)
This 4 picture set shows thi side effect if lamictal (lamotrigine)
Steven’s Johnson Syndrome
