Pharm, Mood Stabilizers, Martin Flashcards
Main drugs used for mood stabilization
lithium carbonate valproate: valproic acid or divalproex carbamazepine lamotrigine atypical antipsychotics
genetics bipolar disrder
first degree relatives 24x more likely to develop bipolar disorder
avg age onset bipolar disorder
21
manic episode
elevated expansive or irritable mood for more than 1 week,
present most of the day
criteria manic episode
3+: distractible talkative pressured speech racing thoughts or flight of ideas hyper-alert: no need for sleep increased activity or psychomotor agitation grandiose hypersexual- risky acts
lithium given how
oral as lithium carbonate
variable effects of lithium
substitutes for Na
changes DA and 5-HT and Ach systems
lithium in phosphoinositide pathway
inhibits enzyme that converts IP2 to IP1 and IP1 to inositol
depletes PIP2 which is source for IP3 and DAG messaging
depletion PIP2 leads to
dec responsiveness to synaptic transmission for R which utilize phosphoinositie messaging
time course for effect on PIP2
2-3 weeks of lithium Tx
adverse effects lithium
tremor! hypothyroidism renal dysfunction: polyuria polydipsia cardiac conduction problems gastric distress mild cognitive impairement edema weight gain
therapeutic window with lithium
very very small
must monitor plasma drug level when put on or change dose
what can increase lithium toxicity
dehydration
what can be used in adjunct with lithium
valproate
carbamazepine
lamotrigine
atypical antipsychotics (be careful)
first line Tx for bipolar
valproic acid used because faster onset than lithium and wider therapeutic window
