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Pharm Block 2 > Mood stabilizers (mania) > Flashcards

Mood stabilizers (mania) Flashcards

1
Q

What is the use for mood stabilizers?

A

Mood stabilizers are medications used to prevent the extreme mood swings between mania and depression typically seen in bipolar disorder

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2
Q

Why is therapeutic drug monitoring required for lithium?

A

The therapeutic range is very narrow and thus requires monitoring

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3
Q

Why is volume of distribution important in lithium administration?

A

The volume of distribution for lithium is approximately equal to body water therefore anything that changes body water can cause a toxic increase in circulating lithium levels

  • Thiazide diuretic use
  • Intense exercise
  • Diarrhea.
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4
Q

What signs of toxicity are associated with lithium?

A

Signs and symptoms of toxicity include:

  • nausea
  • vomiting
  • diarrhea
  • ataxia
  • depressed thyroid function
  • cognitive slowing
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5
Q

What side effects are associated with lithium?

A
  • Lethargy
  • Weight gain
  • Blurred vision
  • Slight tremble in the hands
  • Feeling of being mildly ill
  • Reversible nephrogenic diabetes insipidus also sometimes seen.
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6
Q

To what pharmacologic drug class does lithium belong?

A

Anti-mania, mood stabilizer, headache prophylaxis esp. cluster headaches

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7
Q

What is the (proposed) mechanism of action of lithium?

A
  • Alter Na+ transport in nerve and muscle cells
  • Inhibit the recycling of neuronal membrane phosphoinositides involved in generation of second messengers
  • Inhibition of glycogen synthase kinase 3, inositol phosphatases
  • Modulating glutamate receptors.
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8
Q

What are the major drug interactions with lithium?

A

diuretics, NSAID , ACE inhibitors, calcium channel blockers

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9
Q

What special considerations should be taken with lithium?

A
  • pregnancy risk factor D,
  • CAUTION for hypersensitivity to drug/class
  • Brugada syndrome
  • elderly pts
  • renal impairment, volume depletion
  • cardiovascular disease
  • thyroid disorder
  • concurrent CNS depressant use, alcohol use
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10
Q

What is the route of administration for lithium?

A

by mouth (po)

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11
Q

Which anti-epileptic drugs are also effective for mania?

A

Valproic acid, Carbamazepine, Oxcarbazepine and Lamotrigine

  • See anti-epilepsy deck
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12
Q

What special considerations should be taken with Valproic acid (valproate–see epilepsy deck for full pharm info)?

A
  • Pregnancy risk factor D

- Reduces clearance of carbamazepine and lamotrigine

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13
Q

What should be monitored in patients on Valproate?

A
  • Obtain baseline complete blood cell counts with differential (CBC with diff every 3-6 months)
  • Liver function tests (every 3-6 months)
  • Pregnancy test for females.
  • Monitor for development of polycystic ovary disease in females
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14
Q

What are the black box warnings associated with Valproate?

A

Hepatotoxicity, Teratogenic, Pancreatitis

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15
Q

What are the black box warnings associated with lamotrigine?

A

SERIOUS SKIN RASHES:

  • Requires hospitalization
  • Stevens-Johnson syndrome
  • Rare cases of toxic epidermal necrolysis, and rash-related deaths
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16
Q

What is oxcarbazepine?

A

Oxcarbazepine is a structural derivative of carbamazepine.

  • It has a reduced effect on inducing liver metabolizing enzymes which means less dose modification.
  • More expensive than carbamazapine currently.
  • See carbamazepine cards
17
Q

Describe the pharmacodynamics of oxcarbazepine.

A
  • Blocks voltage-sensitive Na channels (like Carbamazepine with fewer side effects)
  • Stabilizes neural membranes
  • Inhibits repetitive firing, and decrease synaptic impulse propagation
18
Q

To what drug class does olanzapine belong?

A

Atypical anti-psychotic, mood stabilizer

19
Q

Describe the pharmacodynamics of olanzapine.

A

Blocks 5HT2A and D2 receptors similar to clozapine

20
Q

Describe the pharmacokinetics of olanzapine.

A
  • Metabolized extensively by the liver
  • CYP450: 1A2, 2D6 (minor), 2C19 substrate
  • Urine 57% (7% unchanged), feces 30%
  • Half-life: 21-54h
21
Q

What toxicity is associated with olanzapine?

A
  • Drowsiness
  • Flu syndrome
  • Weight gain
  • Salivation
  • Tardive dyskinesia,
  • QTc prolongation (all anti-psychotics)
  • Rarely neuroleptic malignant syndrome.
22
Q

What special considerations should be taken with patients on olanzapine?

A
  • Pregnancy risk factor C (preferred bipolar med. for pregnancy)
  • p450 inducers
23
Q

What is the route of administration for olanzapine?

A
  • p.o.

- IM

24
Q

What should be monitored in patients on olanzapine?

A
  • Fasting glucose and lipid panel at baseline, then periodically
  • AST/ALT if significant hepatic dz
  • CBC frequently during initial TX if pre-existing leukopenia or if drug-induced leukopenia/neutropenia hx
  • Weight
  • Orthostatic hypotension (IM use)
25
Q

Why is olanzapine not approved for dementia related psychosis in elderly patients?

A
  • Increased mortality risk in elderly dementia pts. on conventional or atypical antipsychotics
    • Most deaths due to cardiovascular or infectious events
26
Q

What is the clinical management of a patient during a manic episode?

A

Trials have proved that a combination of an atypical antipsychotic with lithium provides better prophylaxis than does lithium monotherapy, however the weight gain and sedation is prohibitory for many.

Pharm Block 2 (15 decks)

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