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!!!!! Pharm Spring 16 Exam 2 !!!!! > Mood Stabilizers and Antiepileptics > Flashcards

Mood Stabilizers and Antiepileptics Flashcards

1
Q

gold standard in treatment of bipolar disorder

A

Lithium

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2
Q

consitered a mood stabilizer

A

Lithium

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3
Q

Lithium Mechanism of action

A

Competes with Na+, Ca+ and Mg+ affecting cell membranes, H2O and neurotransmitters

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4
Q

Lithium volume of distribution

A

42L, through totoal body water

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5
Q

Lithium excretion

A

Renal excretion

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6
Q

Lithium and the kidney

A
  1. filtered by glomerulus and reabsorbed by the proximal renal tubules
  2. Proximal tubule reabsorbtion of Lithium and Na+ is compeditive
  3. Drugs that act directly on the distal tubule will NOT have any effect on the absorbtion of lithium
  4. If patient has low sodium much more lithium will be absorbed.
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7
Q

labs to monitor with lithium

A

Electrolytes - if patient gets low sodium more lithium will be absorbed at the proximal convoluted tubule

For anestheia know specifically - Na+, Ca++, Mg++, BUN/Creatinine - kidney function

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8
Q

What does Litium compete with? Where?

A

Sodium - at the proximal convoluted tubule

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9
Q

What drug will not have any effect on the absorbtion of lithium? Why?

A

Thiazide diuretics, because they work at the distle tubule and lithium is reabsorbed at the proximal convoluted tubule

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10
Q

What drugs should be avaided with lithium?

A

Anything that alters renal blood flow will increase plama concentration

avoid NSAIDS

NO TORRIDOL

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11
Q

Lithium and Cardiovascular side effects

A

T-wave changes, flattening or inversion

However, there are NO clinical effects with these changes

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12
Q

Renal side effects of lithium

A
  1. Evaluate renal side effects every 6 months
  2. Polydypsia and poluria; >3L/day (think Na)
  3. Imparied renal concetration r/t decreased ADH sensitivity
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13
Q

Lithium side effect more common in females

A

hypothyroidism

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14
Q
  1. new onstet psoriasis/acne
  2. Hand tremor
  3. sedation
  4. memory disturbances/cognitive slowing
  5. polydypsia/polyurea
  6. Twave flattening/inversion
A

Lithium side effects

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15
Q

Lithium and anesthesia

A

anesthesia requiremnents may be decreased and non-depolarizing muscle relaxants effects prolonged- r/t NA manipulation

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16
Q
  1. Sedation
  2. Nausea
  3. Skeletal musle weakness
  4. AV hear block
  5. seizure
  6. confusion in elderly
A

Signs of MILD lithium toxicity

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17
Q

Significant Lithium toxicity

A
  1. Medical emergency
  2. Aggressive treatment
  3. Hemodialysis
  4. Osmotic diuresis (mannitol)
  5. IV bicarbonate (ion trapping - lithium is given as lithum salt- means it is acidic)
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18
Q

When can seizures develop with lithum?

A

Greater than 2 mEq/L

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19
Q

Lithium therepeutic range

A

1 -1.2 mEq/L

Very Narrow therepeutic range

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20
Q

Lithium and pre-op cardiovascualr testing

A

Get an EKG - lithium can cause t wave depression and inversion and need to know so you can identify intraop changes and ischemia

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21
Q

goal of antiepileptic therapy

A

controll seizure without any medicaton related side effects

22
Q

antiepileptics mechanism of action

A
  1. Decrease neuronal excitability altering intrinsic membrane ion conductance (Na+, K+, Ca++)
  2. Enhancement of inhibition of GABA
23
Q

Antiepileptics absorbtion

A

Slow from GI tract

24
Q

Antiepileptics distribution

A

protein binding varies from 0-90%

drugs that competer for protein binding need to be careful with patients with liver and kidney disease, will have more free drug

25
Q

Antiepileptics - metabolism

A

most metabolized by the liver

26
Q

Antiepileptics elimination

A

Renal with their Elimination half time varying from hours to days depending on the drug

27
Q

Lab testing for antiepileptics

A
  1. routine monitoring of plasma concentration (peaks and troughs) guide dosing adjustments
  2. Not a specific therepeutic range, but titrated to individual clinical efficacy
  3. Liver funtion tests and Hematologic studies - many associated with llife threatening bone marrow supressin and hepatotoxicicty
28
Q

Acts by regulating Na+ and Ca+ conductance across neuronal membranes

A

Phenytoin (Dilantin)

29
Q

Acts by Na+ ion channel blockade

A

Fosphenytoin (Cerebyx)

30
Q

Acts by modulation of post synaptic actions of GABA and Glutamate

A

Phenobarbitol

31
Q

Enhances GABA and Inhibits Glutamate

A

Phenobarbitol

32
Q

Potentiate GABA and increase Chloride permeability

A

Benzodiazepenes

33
Q

Water Soluable phenytoin Pro drug

A

Fosphenytoin (cerebyx)

34
Q

pH 12 - precipitates in anything with a pH less than 7.8

A

Phenytoin (Dilantin)

35
Q

Phenytoin dose in adults

A

Loading dose is 1 gm run at 50 mg/min - should take 20 minutes- may need to run slower in HR and BP do not allow

36
Q

Pheytoin dosages in Pediatrics

A

1 -3 mg/kg/min or 50 mg/min - whiever is slower

37
Q

Phenytoin and administration

A
  1. Poorly absorbed GI
  2. Poorly absorbed IM
  3. Given IV
  4. IV infusion given too fast can cuase profound hypotnesion and cardiac arrest!
38
Q

Antiepileptics: HIGHLY protein bound

A
  1. Phenytoin (Dilantin)
  2. Fosphenytoin (Cerebyx)
39
Q

Hepatic metabolism and INDUCER of CY P450 system

A
  1. Phenytoin (dilantin)
  2. Phenobarbitol
40
Q

Is a long acting barbituate

A

Phenobarbitol

41
Q

Phyenytoin and Plasma concentration

A
  1. Less than 10 mcg/ml - eliminated by first order kinetics
  2. Greater than 10 mcg/ml - eliminated by zero order kinetics
42
Q
  1. Peripheral neuropathy
  2. vertigo
  3. diplopia
  4. ataxia
  5. nystagmus
A

CNS toxicity caused by phenytoin

43
Q

Acne , facial coarsening and allergic rash

A

Side effects of Phenytoin (Dilantin)

44
Q

Stevens Johnsons Syndrome

A

Stevens Johnsons syndrome caused by Phenytoin (dialantin)

45
Q

GI Irritation and hepatotoxicity

A

Side effects caused by Phenytoin (Dilantin)

46
Q

Cognitive and behavioral side effects limit its usefulness and make it a 2nd line drug

A

Phenobarbitol

47
Q
  1. Sedation in adults
  2. Sometimes hyperactivity in children
  3. Depression
A

Phenobarbitol

48
Q

Fosphenytoin dosages

A

Loading dose: 10-20 mg/kg IV

49
Q

Confusion in the elderly

A

Phenobarbitol

50
Q
  1. skeletal muscle incoordination and ataxia
  2. hypotnesion
  3. sedation
  4. respiratory depression
A

Benzodiazepenes

!!!!! Pharm Spring 16 Exam 2 !!!!! (11 decks)

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