Mood Stabilizers & Antiepileptics Flashcards
What is lithium used for
Bipolar disorder, especially to treat manic phase of bipolar disorder. It is used PROPHYLACTICALLY or acute mania and for maintenance
What is lithium classified as
Mood stabilizer
What is the most common side effect of lithium in terms of acute and chronic
Acute lithium toxicity begins with GI symptoms (nausea, vomiting, diarrhea). Chronic Lithium toxicity leads to development of neurologic symptoms including confusion, tremor, and ataxia.
What is a side effect off lithium even at therapeutic levels
Tremor
What are the 2 less common side effects of lithium?
(1) Nephrogenic diabetes insipidus(2) Hypothyroidism
What drugs can’t be taken with lithium and why?
NSAIDs and thiazides, since they reduce renal clearance of lithium, this can lead to diabetes insipidus
Can lithium be taken in pregnancy? Explain.
No, teratogenic as it leads to Ebstein abnormality
Explain Ebstein abnormalities
Atrial septal defect, an atrialized right ventricle and a malformed tricuspid
What tests can be done to check for ebstein abnormality and what is seen in it?
Echo, shows anatomic defects with tricuspid regurgitation
Summarize the side effects of lithium
Has a narrow therapeutic index so has many AE:(1) Acute AE are GI side effects, chronic are neurological AE(2) Tremor at therapeutic doses(3) Nephrogenic diabetes insipidus(4) Hypothyroidism(5) Teratogenic - Ebstein anomally(6) Cant be taken with NSAIDs and thiazides
What is the role of anti epileptic drugs in treating bipolar disorder?
The following are anti epileptic drugs that can be used as prophylaxis therapy for bipolar disorder:Valproate, carbamazepine and lamotrigine
What is a first line therapy for treating acute mania?
Valproate
What is the role of anti psychotics in treating bipolar disorder
1st generation (haloperidol) and 2nd generation (quetiapine) antipsychotics can be used to treat acute mania
Compare and contrast treatment of bipolar disorder with anti epileptics and anti psychotics
Anti epileptics for prophylaxis and anti psychotics for acute mania treatment
What are focal seizures
Seizure occurs at focal portion of brain
What are simple focal seizures
Focal seizures with NO loss of consciousness
What are complex focal seizures
Focal seizures with loss of consciousness
What are generalized seizures
Occurs in both hemispheres of the brain at onset
What can partial seizures progress to?
Can become generalized seizures
What is juvenile myoclonic epilepsy
a generalized seizure in kids with NO loss of consciousness
What is valproate, explain its MOA and use
Valproate is a broad spectrum antiepileptic drug that works by binding voltage gated-Na+ channels, thereby preventing the sustained high frequency firing of neurons -> extends the duration of inactivated phase of these channels
How does valproate effect GABA receptors in CNS?
Does not directly effect GABA receptors but may also cause an increase GABA levels in the CNS
AE of valproate
Most common side effects are nausea and vomiting, but it can also increase appetite and cause weight gain
AE of valproate at higher levels
Causes tremor, a rare but potentially fatal side effect is hepatoxicity.Also causes pancreatitis
Can valproate be taken in pregnancy?
No, its teratogenic, the babies have much higher risk of neural tube defects, including spina bifida
Summarize different types of seizures including JME
Focal Seizures = occurs at focal portion of brainSimple focal seizures = no loss of consciousnessComplex focal seizures = loss of consciousnessGeneralized Seizures = occurs in both hemispheres of the brain at onset.Juvenile myoclonic epilepsy (JME) - a generalized seizure in kids with no loss of consciousness
What is Topiramate, explain its MOA and its use
Topiramate - is a broad spectrum antiepileptic drug, works by binding voltage gated-Na+ channels, thereby preventing the sustained high frequency firing of neurons -> extends the inactivated phase of these channels
What is the mechanism of side effects associated with topiramate
Topiramate allosterically binds to the GABA-A receptor: cause dose-related somnolence, fatigue, confusion, and cognitive slowing.
What are other side effects of topiremate
Weight loss, Nephrolithiasis/urolithiasis, myopia and acute angle closure glaucoma