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.
What are the 3 types of anticonvulsants (seizure meds)?
Valproate
Carbamazepine
Lamotrigine
What is the MAO of valproate?
Valproate is what kind of medicine?
Unclear;
Anti-manic only, there are NO antidepressant effects
Valproate is a good choice for “____”
Rapid cyclers
Does valproate work more quickly or more slowly than lithium?
More quickly
How can depressive episodes of BPD be treated?
With a mood stabilizer alone OR with a mood stabilizer + antidepressant but NEVER with an antidepressant alone (because hypomania or mania might occur)
What does valproate have a black box warning for?
Pancreatitis
Hepatoxicity (especially children)
Women taking valproate have a risk for what syndrome?
Polycystic ovarian syndrome
-About 10% of women
What pregnancy category is valproate? Why?
D; can cause neural tube defects like spina bifida
What is the MOA of carbamazepine?
Unclear
What kind of treatment does carbamazepine produce?
Anti-manic
No anitdepressant effect
What are the side effects of carbamazepine?
Aplastic anemia
Cognitive fog
Steven-Johnson syndrome
What is aplastic anemia?
Bone marrow does not produce more cells (of all of them RBC, WBC, and platelet). This can be life threatening. Only 5/1,000,000 will develop this
Are drug interactions a serious concern when taking carbamazepine?
Yes
What is the MAO of lamotrigine?
Unclear
Is lamotrigine a good anti-depressant?
Pretty good antidepressant
Is lamotrigine a good anti-manic agent?
No
What is the good news if you are taking lamotrigine?
No blood tests needed because there is a wide therapeutic range
Little or no weight gain
Not very sedating
Why are atypical antipsychotics preferred over conventional antipsychotics
Atypical agents carry a lower risk of extrapyramidal side effects; they are preferred for BPD
