mood stabilizers Flashcards
exam 2
lithium resembles which other element?
sodium
Role of lithium
- alters Na transport in nerve and muscle cells
lithium is standard therapy for
mania and bipolar
onset of lithium
may take days to weeks for full effect
acute symptoms of disorders that require lithium might also require additional therapy from
benzodiazepines or antipsychotics
lithium has a large or small therapeutic window
small window
SE of lithium that is transient
nausea, diarrhea, fatigue
SE of lithium with persistence
tremor, weight gain, polyuria, polydipsia
lithium drug interactions:
those that increase lithium levels
- ACE inhibitors
- Diuretics like HTZ
- NSAIDs
lithium drug interactions :
those that cause a decrease in lithium levels
- diuretics that are K-sparring
valporic acid, carbamazepine and lamotrigine all belong to the family of
anti-convulsants
anticonvulsants mechanisms (3)
- modulation of voltageGIC involved in propagating the Action potential
- enhancement of inhibitory activity: GABA
- inhibition of excitatory activity: glutamate/aspartate
SE of anticonvulsants
- CNS
- increased risk for suicide
- drug interactions
role of valproic acid
- alternative to lithium; has FDA indication for mania and bipolar
- MOA: increased GABA levles
onset of valproic acid?
what about therapeutic window?
ma be quicker than Lithium
- small therapeutic window
black box warnings for valproic acid?
- neural tube defects
- fatal hepatoxicity
- pancreatitis
role of Carbamazepine
- to those that are intolerant or unresponsive to LI/VA- FDA indication for mania and bipolar
- MOA: stabilizes sodium channels
onset of carbamazepine?
therapeutic window?
- May be quicker than Li
narrow therapeutic window
metabolism of carbazepine includes which nezym
CYP34A
10,11-CBZ epoxide associated with
severe SE
carbamazepine black box
- agrunolocytosis and aplastic anemia
- rashes (HLA-B1502)
carbamazepine can promote the release of
ADH from the pituitary gland
oxcarbazepine is a derivation of carbamazepine
what is the difference btw. them?
- less CYP450 involvment
- no 10,11 epoxide
-fewer overall SE
might be some higher hyponatremia SE
black box warning from lamotrigine
rashes- importance of dose tritration
A 33 yo patient with a history of bipolar disorder is currently treated with valproic acid after failing to tolerate lithium therapy. What should be monitored to ensure the safety of the current medication?
LFTs + amylase/ lipase
