Mood stabliizers Flashcards
Symptoms of Hypomania/ManiaDIGFAST
Distractibility: Insomnia: Grandiosity: Flight of Ideas: Activity increased: Speech pressured: Thoughtlessness:
Lithium (Lithobid, Eskalith, Lithane)
(12 and up)
Acute Mania and Bipolar maintenance
MOA
Presynaptic modification of release and synthesis of Serotonin (5HT) and Norepinephrine
Inhibits (cAMP)
Modulates Dopamine (D2)
Onset- 5-7d
TE- 10-24d
Renally cleared monitro CrCL
Note equal does of carbonate or citrate
Lithium ADR
Dose related
Polyuria, polydypsia, cognitive problems, tremor, sedation/lethargy, impaired coordination, edema, GI distress (diarrhea)
Hypothyroidism, alopecia, benign leukocytosis, acne, wt. gain
Pregnancy preacuations
Mild level- muscle fatigue, gi
Mod levels- twtiching, slurred speech
Severe- Death, seizures
DI-Diuretics, Phonotiaxine-EPS, toxicity
Theophylien caffiecn- dec
D/c salts can l/t toxicity
Monitor- LFT, NA, SCR
Valproic Acid (Depakene)Divalproex Sodium (Depakote, Depakote ER)
Regulates GABA synthesis, release, and uptake
Normalizes Na+ and Ca+ channels
Equally effective as lithium for acute mania
No evidence for maintenance, however used in clinical practice
TE- 1-4d, need loading dose
ADR- Dose related **
GI, sedation, INc appetite, wt, gain
Monitor CBC, LFT
DI-
Clonazepam – severe drowsiness & loss of seizure control
CBZ, phenytoin, phenobarbital, primidone, rifampin - dec
Increased -Aspirin
Diazepam, phenobarbital, primidone, phenytoin, warfarin
Carbamazepine
Proposed to stabilize membranes of excitable neurons
decrease release of NE with chronic therapy
Therapeutic onset: several weeks
Hepatic metabolism, **auto-induces metabolism, induces own metabl
Slow Dose Initiate:
Lots of Drug Interactions!
Decreased serum levels
Neuroleptics, BDZ (except clonazepam), TCAs, anticonvulsants, thyroid hormones, warfarin, theophylline
Carbamazepine ADE
Dose related:
Diplopia, blurred vision, fatigue, nausea, ataxia, nystagmus, confusion
Less frequent:
Skin rashes,
Pregnancy/Lactation- should be avoided**
Monitor LFT, CBC
Oxcarbazepine (Trileptal)
pro-drug for metabolite of carbamazepine
Reportedly less ADE, but actually very similar to carbamazepine
Drug interactions: verapamil, phenobarb, valproic acid reduce levels; reduced efficacy of birth control pills
Lamotrigine (Lamictal)
MOA: unknown; used for seizures and bipolar
Hepatically cleared
Special dosing and titration schedules
Black box warning – rash, Stevens-Johnson syndrome-rash
Drug Interactions:
Enzyme inducers: CBZ, phenytoin, rifampin, phenobarbital: reduce lamotrigine levels
Oral contraceptives : may increase or decrease
Valproic acid: increased lamotrigine levels
Acute Manina
Li, VPA, CBZ as indicated
Atypical Antipsychotics
Agitation: benzodiazepine, parenteral antipsychotic
Other mood stabliizers
Atypical SGA
Olanzapine-acute
Fixed w/ fluextine
Risperidone, quetiapine and aripiprazole also effect
Bipolar Depression
SSRI (esp paroxetine) and bupropion least risk of manic switching
Divalproex and carbamazepine less effective for depression
