Mood Stabilizers and Anti-convulsants Flashcards
What are conditions/situations are mood stabilizers used for?
- 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)
List mood stabilizers
- LITHIUM
- and ANTI-CONVULSANTS: valproic acid, lamotrigine, carbamazepine
What is the drug of choice for acute mania?
lithium
What is the only mood stabilizer shown to dec risk of suicidality?
lithium
Lithium is metabolized by what organ?
Kidney must adjust in patients with renal dysfunction
What drugs are blood levels useful for (clinical efficacy correlate)?
lithium, VPA, carbamezapine, clozapine
What is the major drawback of lithium?
high incidence of side effects and carry narrow therapeutic index (therapeutic 0.6-1.2, toxic >1.5, lethal >2.0)
Toxic levels of lithium can cause…
altered mental status, coarse tremors, convulsions, death
Side effects of lithium?
fine tremor, nephrogenic diatbetes insipidus, GI disturbance, weight gain, sedation, thyroid enlargement, hypothyroidism, ECG changes, benign leukocytosis
If taken during pregnancy, lithium can cause…
Ebstein’s anomaly- cardiac defect in babies
What factors may decrease Lithium levels?
NSAIDS (aspirin, diuretics especially thiazides)
- be careful prescribing ibuprofens
What factors may increase Lithium levels?
Dehydration, salt deprivation, sweating (salt loss), impaired renal function (aspirin, diuretics especially thiazides)
Which anticonvulsant is most useful in treating mixed episodes and rapid-cycling bipolar disorder, but is less effective for the depressed phase?
Carbamazepine (Tegretol), (Oxacarbazepine/Trileptal as well and also better tolerated–>less risk of rash and hepatic toxicity)
Which anticonvulsant also used to manage trigeminal neuralgia?
Carbamazepine (Tegretol)
Carbamazepine (Tegretol) specific side effects?
- 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
Carbamazepine (Tegretol) toxicity causes…
confusion, stupor, motor restlessness, ataxia, tremor, nystagmus, twitching, vomiting
Neural tube defects can occur when what anticonvulsants are used during pregnancy?
Carbamazepine (Tegretol) and valproic acid (Depakote)
What anticonvulsant has significant drug interactions with those metabolized by cytochrome P450 pathway, including its own metabolism (auto induction)?
Carbamazepine (Tegretol)
What is the normal range of VPA? How often should drug levels be checked?
50-150 mcg/mL
3-5 days
What should be monitored with VPA?
LFTs and CBC
What anticonvulsants have efficacy for bipolar depression, but little for acute mania/prevention of mania?
Lamotrigine (Lamictal)
Most common side effects of Lamotrigine (Lamictal)? Most serious side effect?
dizziness, sedation, headaches, ataxia
SJS in 10% (most likely in 4-6 weeks)
How do VPA and Lamotrigine affect one another?
VPA will inc lamotrigine and lamotrigine with dec VPA
Gabapentin (Neurontin) can be used for…
adjunct therapy for anxiety and sleep
Pregabalin (Lyrica) can be used for…
GAD and fibromyalgia
Tiagabine (Gabitril) can be used for…
possibly anxiety
Topiramate (Topamax) can be used for…
impulse control and anxiety
Topiramate (Topamax) specific side effects?
- weight loss
- hypochloremic, non-anion gap metabolic acidosis and kidney stones
- cognitive slowing
VPA side effects?
- GI side effects
- weight gain
- sedation
- alopecia
- pancreatitis
- hepatotoxicity or benign aminotransferase elevations
- inc ammonia
- thrombocytopenia
