Mood Stabilizers - Martin

Question 1

tx of acute mania and prevent mania in bipolar

Answer 1

lithium

Question 2

use caution in pregnant

Answer 2

lithium

Question 3

CI in pregnant

Answer 3

valproic acid
divalproex
carbamazepine

Question 4

agranulocytosis and aplastic anemia

Answer 4

rare - with carbamazepine

Question 5

maintenance tx of bipolar

Answer 5

aripiprazole

olanzapine

Question 6

tx of major depression with bipolar

Answer 6

olazapine and fluoxetine combom
quetapine
lurasidone

Question 7

sedate agitated patient

Answer 7

benzos - lorazepam

lithium - 1-3 weeks to see clinical response

Question 8

manic episode

Answer 8

period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy

• lasting at least 1 week and present most of day
• nearly every day

need 1 lifetime manic episode - to diagnose bipolar disorder

Question 9

lithium PK

Answer 9

kidney excretion

handled similar to sodium

reabsorbed prox tubes

Question 10

MOA lithium

Answer 10

attenuate signaling via receptors coupled to PIP2 2nd messenger system

interferes resynthesis of PIP-2

depletion in neuronal membranes of CNS
-no effect on peripheral membranes

disrupts IP3/DAG intracellular signaling

also inhibit glycogen synthase kinase-3

Question 11

lithium and valproate

Answer 11

take days to weeks to become effective

Question 12

acute manic patient

Answer 12

antipsychotic and benzo tx

Question 13

tx of depression in bipolar pt

Answer 13

lithium protect against suicide and self harm

Question 14

maintenance therapy of bipolar

Answer 14

lithium alone or in combo with valproate, carbamazepine, or lamotrigine
-decreased risk of recurrent manic and depressive episodes

Question 15

long acting risperidone IM every 2 weeks

Answer 15

approved for maintenance therapy of bipolar

frequent relapse or poor adherence patients

Question 16

before tx with lithium

Answer 16

kidney function test
-creatinine and urine specific gravity

thyroid function

kidney fxn - 1-2x/year

Question 17

lithium dosing

Answer 17

narrow therapeutic window

Question 18

signs of lithium toxicity

Answer 18

tremor**
dysarhria
delirium
coma
seizures
autonomic instability

Question 19

dehydration

Answer 19

increases lithium reabsorption

-lead to toxicity

Question 20

monitor lithium plasma levels

Answer 20

every 3 months initially

every 6-12 months once stabilized

Question 21

target serum lithium

Answer 21

0. 8-1.2 - acute tx

0. 6-1 - maintenance

Question 22

rapid discontinue of lithium

Answer 22

risk of relapse and possible suicide

should taper slowly over 3 months

Question 23

lithium tremors

Answer 23

tx - propranolol

Question 24

long term lithium

Answer 24

hypothyroid

Question 25

nephrogenic diabeties insipidus

Answer 25

with lithium tx

-increased risk lithium toxicity and may be irreversible

Question 26

increase lithium concentrations

Answer 26

NSAIDs, ACE Is, diuretics

Question 27

decrease lithium levels

Answer 27

theophylline and caffeine

Question 28

dehydration

Answer 28

increase lithium levels

Question 29

lithium during pregnancy

Answer 29

congenital cardiac abnormalities

low APGAR, longer hospital stays, reversible neuro toxicity

Question 30

monitor with lithium tx

Answer 30

renal function

thyroid function

Question 31

rapid cycling bipolar

Answer 31

valproate

Question 32

valproate

Answer 32

better for manic than depression in bipolar

Question 33

tx complex partial seizures and absence seizures

Answer 33

valproate

Question 34

grand mal seizures tx

Answer 34

valproate

Question 35

adverse of valproate

Answer 35

GI upset

weight gain

polycystic ovary
insulin resistance
lipid abnormal
hirsutism
hypothyroid

Question 36

monitor in pt taking valproate

Answer 36

liver function

Question 37

thrombocytopenia

Answer 37

with valproate

Question 38

adverse of carbamazepine

Answer 38

rash, dizzy, diplopia, nausea, somnolence, HA, hypoNa

Question 39

steven-johnson syndrome

Answer 39

with carbamazepine

Question 40

monitor with carbamazepine

Answer 40

CBC

aplastic anemia and agranulocytosis

Question 41

tx of partial seizures and secondary general tonic-clonic seizures

Answer 41

carbamazepine

Question 42

lamotrigine

Answer 42

maintenance tx of bipolar

Question 43

lamotrigine MOA

Answer 43

blocks sodium channels and high voltage dependent calcium channels

Question 44

adverse of lamotrigine

Answer 44

dizzy
ataxia
somnolence
HA
diplopia
nausea
vomiting
rash
insomina

Question 45

pregnancy and valproate

Answer 45

neural tube defects

Question 46

carbamazepine and pregnancy

Answer 46

risk malformation
-neural tube defects
vit K deficiency - neonatal hemorrhage

Question 47

second gen antipsychotics

Answer 47

tx of mania in bipolar disorder

added on with lithium or valproate

Question 48

tx of depression in bipolar

Answer 48

selected antipsychotics - quetiapine, lurasidone, olanzapine, fluoxetine

Question 49

monotherapy of antipsychotics in bipolar

Answer 49

can precipitate manic episodes

Question 50

bipolar disorder

Answer 50

first degree relative 24x likely to get it

-huge genetic component

Question 51

manic episode DTRHIGH

Answer 51

distractable
talkative
racing thoughts
hyperalert - decreased need for sleep**
increased activity
grandiose
hypersexual

need 3 or more - 4 if irritable mood

Question 52

20-40% bipolar pt

Answer 52

don’t respond to lithium