Mood stabilizers (another set to look at) Flashcards
What are mood stabilizers used for?
Bipolar disorder
What are the 3 mood stabilizer classes?
Lithium
Anticonvulsants
Atypical antipsychotics
What are mood stabilizers? (3)
Relieve symptoms during manic and depressive episodes
Prevent recurrence of manic and depressive episodes
Do not worsen symptoms of mania or depression, or accelerate the rate of cycling
In patients with BPD, when are antipsychotic drugs given?
During severe manic episodes, to help control symptoms even if psychotic symptoms are absent
In patients with BPD, when are antidepressants needed to be given?
During a depressive episode
Why are antidepressants ALWAYS given with a mood stabilizer?
Because of the long term belief that giving an antidepressant alone with elevate mood so much that a hypomanic or manic episode will occur
What are the antidepressants that are most commonly prescribed in patients with BPD?
Bupropion
Venlafaxine
SSRIs (specifically fluoxetine and sertraline)
What are the 2 mood stabilizing drugs used for acute management during a manic episode? Which is preferred more?
Lithium and valproate;
Valproate is preferred in most cases, although lithium is preferred if the patient is having a euphoric manic episode
Does lithium have a wide or narrow therapeutic index? Explain
Narrow; it is narrow so monitoring lithium levels is mandatory
Testing every 7 days the first few weeks
Once every 3 months after stabilization
What is the MOA of lithium?
Unclear
What are some expected side effects of lithium?
Fine hand tremor (interfere with writing and other motor skills) Polyuria (increased urination) Mild thirst Mild nausea/GI discomfort Weight gain (~10-20lbs)
What if the side effects of lithium are worse than what we are expecting them to be?
Ex: expected side effect is fine hand tremor, what if we are seeing a coarse hand tremor?
We begin to worry because lithium has a NARROW therapeutic range
What are some other concerns with lithium?
Can you take lithium if you are pregnant?
Hypothyroidism and renal impairment
Lithium may be teratogenic so should be avoided during first trimester. Unless the benefits outweigh the risks, it should also being avoided during second and third trimester.
What is important to teach the patient when prescribing them lithium?
That even when you begin to feel better, you need to continue taking the drug
Don’t drastically change sodium levels, and continue drinking water regularly!
Why must the patient be informed about not drastically changing their sodium intake when prescribed lithium?
Lithium is a salt; kidneys cannot tell the difference between sodium and lithium
A reduction in sodium levels will reduce lithium excretion, causing lithium to accumulate–possibly to toxic levels. Patients must maintain normal sodium intake levels.
