Mood Stabilizers - Martin Flashcards
tx of acute mania and prevent mania in bipolar
lithium
use caution in pregnant
lithium
CI in pregnant
valproic acid
divalproex
carbamazepine
agranulocytosis and aplastic anemia
rare - with carbamazepine
maintenance tx of bipolar
aripiprazole
olanzapine
tx of major depression with bipolar
olazapine and fluoxetine combom
quetapine
lurasidone
sedate agitated patient
benzos - lorazepam
lithium - 1-3 weeks to see clinical response
manic episode
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
lithium PK
kidney excretion
handled similar to sodium
reabsorbed prox tubes
MOA lithium
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
lithium and valproate
take days to weeks to become effective
acute manic patient
antipsychotic and benzo tx
tx of depression in bipolar pt
lithium protect against suicide and self harm
maintenance therapy of bipolar
lithium alone or in combo with valproate, carbamazepine, or lamotrigine
-decreased risk of recurrent manic and depressive episodes
long acting risperidone IM every 2 weeks
approved for maintenance therapy of bipolar
frequent relapse or poor adherence patients
before tx with lithium
kidney function test
-creatinine and urine specific gravity
thyroid function
kidney fxn - 1-2x/year
lithium dosing
narrow therapeutic window
signs of lithium toxicity
tremor** dysarhria delirium coma seizures autonomic instability
dehydration
increases lithium reabsorption
-lead to toxicity
monitor lithium plasma levels
every 3 months initially
every 6-12 months once stabilized
target serum lithium
- 8-1.2 - acute tx
0. 6-1 - maintenance
rapid discontinue of lithium
risk of relapse and possible suicide
should taper slowly over 3 months
lithium tremors
tx - propranolol
long term lithium
hypothyroid
nephrogenic diabeties insipidus
with lithium tx
-increased risk lithium toxicity and may be irreversible
increase lithium concentrations
NSAIDs, ACE Is, diuretics
decrease lithium levels
theophylline and caffeine
dehydration
increase lithium levels
lithium during pregnancy
congenital cardiac abnormalities
low APGAR, longer hospital stays, reversible neuro toxicity
monitor with lithium tx
renal function
thyroid function
rapid cycling bipolar
valproate
valproate
better for manic than depression in bipolar
tx complex partial seizures and absence seizures
valproate
grand mal seizures tx
valproate
adverse of valproate
GI upset
weight gain
polycystic ovary insulin resistance lipid abnormal hirsutism hypothyroid
monitor in pt taking valproate
liver function
thrombocytopenia
with valproate
adverse of carbamazepine
rash, dizzy, diplopia, nausea, somnolence, HA, hypoNa
steven-johnson syndrome
with carbamazepine
monitor with carbamazepine
CBC
aplastic anemia and agranulocytosis
tx of partial seizures and secondary general tonic-clonic seizures
carbamazepine
lamotrigine
maintenance tx of bipolar
lamotrigine MOA
blocks sodium channels and high voltage dependent calcium channels
adverse of lamotrigine
dizzy ataxia somnolence HA diplopia nausea vomiting rash insomina
pregnancy and valproate
neural tube defects
carbamazepine and pregnancy
risk malformation
-neural tube defects
vit K deficiency - neonatal hemorrhage
second gen antipsychotics
tx of mania in bipolar disorder
added on with lithium or valproate
tx of depression in bipolar
selected antipsychotics - quetiapine, lurasidone, olanzapine, fluoxetine
monotherapy of antipsychotics in bipolar
can precipitate manic episodes
bipolar disorder
first degree relative 24x likely to get it
-huge genetic component
manic episode DTRHIGH
distractable talkative racing thoughts hyperalert - decreased need for sleep** increased activity grandiose hypersexual
need 3 or more - 4 if irritable mood
20-40% bipolar pt
don’t respond to lithium
