Mood Stabilizers Jeopardy Flashcards
lithium Trough level drawn at?
12 hours after last dose
Lithium
TX: bipolar disorder
levels above 0.6-0.8 mEq/L
Male pts before starting- do labs (TSH, BUN/creatine)
maintenance labs - TSH, lithium levels, BUN/creatine
DEC suicide risk
TX acute manic episode
AE - Weight gain, sedation
T1/2 = 5 days (check levels at day 5 after starting)
Tremors
lithium AE
worsen by caffeine
improved w/ propranolol
Lithium toxicity
> 4.0 mEq/L
TX - Dialysis
INC risk x pts: renal impairment, sodium depletion, dehydration
Divalproex Sodium
Depakote
first trimester of pregnancy: INC risk of neural tube defects (spina bifida)
Labs: LFT’s, platelets
AE - HA, weight gain, sedation
INC risk 2 yo - AE: fatal, hepatoxicity
TX - prophylaxis migraine
after last dose trough level (immediate release) - 12 hrs trough level (extended release) - 18 hrs
+aspirin -> INC risk thrombocytopenia (dec platelets)
generic Valproic acid (depakene) VS enteric coated divalproex (depakote)
INC risk of GI side effect
(N/V/D, GI discomfort)
Labs: blood levels, platelets/blood count/Liver function test
Carbamazepine
tegretol
T1/2 dec to less than 50% of initial bc of auto-induction
neural tube defects - first trimester
black box 0.001%: agranulocytosis, aplastic anemia
Low Sodium
CYP3A4 - inducer, substrate
+hormonal birth control: INC risk of pregnancy
Labs: blood levels, platelets/blood count/Liver function test
Oxcarbamazepine
trileptal
TX - bipolar disorder
fewer AE than carbamazepine
Folate
DEC risk of birth defects
women taking carbamazepine
Lamotrigine
lamictal
10% of developing benign rash
severe rash 0.3%
Steven’s Johnson Syndrome 0.02 - 0.1%
NOT x acute manic episode
NO weight gain, NO sedation
Lamitrogen + Divalproex sodium
lamictal’s blood level INC (DOUBLES)
+ Lamotrigine -> dec [ ] of lamotrigine dose by half
Bipolar Depression TX FDA
Lamotrigine (lamictal) Quetiapine (seroquel) lithium Olanzapine/fluoxetine (symbyax) lurasidone (Latuda)
Bipolar TX-Maintenance
Lamotrigine Lithium Quetiapine Olanzapine Aripiprazole
Acute manic episode TX
Lithium Divalproex Carbamazepine ER Quetiapine Ziprasidone Asenapine
MOA:
Carbamazepine
Divalproex
Lamotrigine
mood stabilizers
Block sodium channels
Olanzapine
Zyprexas
SGA
TX: acute manic, maintenance and tx bipolar
long acting injectable form
AE - weight gain, elevated lipids, diabetes
Ziprasidone
geodon
TX - acute mania, maintenance and tx bipolar
taken with FOOD or >50% will not be absorbed in digestive tract
NO metabolic syndrome
CI: QTc >500msec
Aripiprazole
abilify
SGA
TX - acute mania, maintenance and tx bipolar
LONG T1/2 = 75 hrs
long acting injectable form
steady sate @ 2 weeks
NO metabolic syndrome
Risperidone
risperdal
SGA
TX - acute mania, maintenance and tx bipolar
at HIGH doses (>6mg) = FGA
INC AE - EPS
long acting injectable form
Asenapine
saphris
SGA
TX - acute mania
SUBLINGUAL
if swallowed, 5% bioavailability (1st pass metabolism)
Paliperidone
invent sustenna
SGA
long acting injectable form
