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Psychiatry > Mood Stabilizers and Anti-convulsants > Flashcards

Mood Stabilizers and Anti-convulsants Flashcards

1
Q

What are conditions/situations are mood stabilizers used for?

A
  • ACUTE MANIA
  • prevent relapses of manic episodes in BIPOLAR and SAD
  • potentiation of antidepressants refractory to mono therapy
  • potentiation of antipsychotics in SCZ
  • enhancement of abstinence in Rx of alcoholism
  • Rx of aggression and impulsivity (dementia, intoxication, mental retardation, personality disorders, general medical conditions)
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2
Q

List mood stabilizers

A
  • LITHIUM

- and ANTI-CONVULSANTS: valproic acid, lamotrigine, carbamazepine

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3
Q

What is the drug of choice for acute mania?

A

lithium

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4
Q

What is the only mood stabilizer shown to dec risk of suicidality?

A

lithium

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5
Q

Lithium is metabolized by what organ?

A

Kidney must adjust in patients with renal dysfunction

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6
Q

What drugs are blood levels useful for (clinical efficacy correlate)?

A

lithium, VPA, carbamezapine, clozapine

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7
Q

What is the major drawback of lithium?

A

high incidence of side effects and carry narrow therapeutic index (therapeutic 0.6-1.2, toxic >1.5, lethal >2.0)

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8
Q

Toxic levels of lithium can cause…

A

altered mental status, coarse tremors, convulsions, death

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9
Q

Side effects of lithium?

A

fine tremor, nephrogenic diatbetes insipidus, GI disturbance, weight gain, sedation, thyroid enlargement, hypothyroidism, ECG changes, benign leukocytosis

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10
Q

If taken during pregnancy, lithium can cause…

A

Ebstein’s anomaly- cardiac defect in babies

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11
Q

What factors may decrease Lithium levels?

A

NSAIDS (aspirin, diuretics especially thiazides)

  • be careful prescribing ibuprofens
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12
Q

What factors may increase Lithium levels?

A

Dehydration, salt deprivation, sweating (salt loss), impaired renal function (aspirin, diuretics especially thiazides)

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13
Q

Which anticonvulsant is most useful in treating mixed episodes and rapid-cycling bipolar disorder, but is less effective for the depressed phase?

A

Carbamazepine (Tegretol), (Oxacarbazepine/Trileptal as well and also better tolerated–>less risk of rash and hepatic toxicity)

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14
Q

Which anticonvulsant also used to manage trigeminal neuralgia?

A

Carbamazepine (Tegretol)

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15
Q

Carbamazepine (Tegretol) specific side effects?

A
  • GI and CNS (drowsiness, ataxia, sedation, confusion)
  • possible skin rash, SJS
  • leukocytopenia, hyponatremia, aplastic anemia, thrombocytopenia, agranulocytosis must monitor CBC
  • elevation of liver enzymes causing hepatitis must monitor LFTs
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16
Q

Carbamazepine (Tegretol) toxicity causes…

A

confusion, stupor, motor restlessness, ataxia, tremor, nystagmus, twitching, vomiting

17
Q

Neural tube defects can occur when what anticonvulsants are used during pregnancy?

A

Carbamazepine (Tegretol) and valproic acid (Depakote)

18
Q

What anticonvulsant has significant drug interactions with those metabolized by cytochrome P450 pathway, including its own metabolism (auto induction)?

A

Carbamazepine (Tegretol)

19
Q

What is the normal range of VPA? How often should drug levels be checked?

A

50-150 mcg/mL

3-5 days

20
Q

What should be monitored with VPA?

A

LFTs and CBC

21
Q

What anticonvulsants have efficacy for bipolar depression, but little for acute mania/prevention of mania?

A

Lamotrigine (Lamictal)

22
Q

Most common side effects of Lamotrigine (Lamictal)? Most serious side effect?

A

dizziness, sedation, headaches, ataxia

SJS in 10% (most likely in 4-6 weeks)

23
Q

How do VPA and Lamotrigine affect one another?

A

VPA will inc lamotrigine and lamotrigine with dec VPA

24
Q

Gabapentin (Neurontin) can be used for…

A

adjunct therapy for anxiety and sleep

25
Q

Pregabalin (Lyrica) can be used for…

A

GAD and fibromyalgia

26
Q

Tiagabine (Gabitril) can be used for…

A

possibly anxiety

27
Q

Topiramate (Topamax) can be used for…

A

impulse control and anxiety

28
Q

Topiramate (Topamax) specific side effects?

A
  • weight loss
  • hypochloremic, non-anion gap metabolic acidosis and kidney stones
  • cognitive slowing
29
Q

VPA side effects?

A
  • GI side effects
  • weight gain
  • sedation
  • alopecia
  • pancreatitis
  • hepatotoxicity or benign aminotransferase elevations
  • inc ammonia
  • thrombocytopenia

Psychiatry (7 decks)

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