Pharm psych 3 - Anticonvulsants and Anxiolytics/hypnotics Flashcards
What are the major examples of anticonvulsants used in psych?
Carbamazepine (Tegetrol), Lamotrigine (lamictal), valproic acid (depakote, depakene), oxcarbazepine (trileptal), gabapentin (neurontin), pregabalin (lyrica)
What is valproic acid used for? What should be monitored? What is the normal drug level? When should they be checked?
Used for treating mixed episodes of bipolar as well as rapid cycling. LFTs and CBCs should be monitored. Check levels 3-5 days after initiation. Normal range is 50-150 mg/mL.
What is the generic name for lamictal? What is it used for and how does it work? Common side effects? Most series side effect?
x Lamotrigine - efficacious for bipolar depression, though little efficacy for acute mania or mania prevention - works on sodium channels that modulate glutamate and aspartate. - most common side effects: dizziness, sedation, headaches, ataxia - most serious side effect is SJS. most likely in 4-6 weeks but avoid by starting low
How do valproate and lamotrigine affect each other?
Valproate increases lamotrigine levels. And lamotrigine decreases valproate levels.
What is the generic name for neurontin? What kind of drug is it?
Gabapentin - anticonvulsant
Gabapentin (neurontin) is used for?
Used adjunctively to help with anxiety, sleep. Little efficacy in bipolar disorder
What is pregabalin’s brand name?
Lyrica
What is pregabalin used for?
GAD and fibromyalgia. Little efficacy in bipolar disorder
What is tegetrol’s generic name?
Carbamazepine.
What is carbamazepine used for? What’s the broad drug class?
useful in treating mixed episodes and rapid cycling bipolar disoder, less effective for depressed phase. Also used in management of trigeminal neuralgia. Broad drug class = anticonvulsants
What is the MOA for carbamazepine? When is the onset of action? What labs have to be checked?
Acts by blocking sodium channels and inhibiting action potentials. Onset of action if 5-7 days. CBC and LFTs must be obtained before treatment and monitored regularly.
what are the 1) most common side effects 2) drug interactions and 3) toxicity
1) GI and CNS disturbances most common (ataxia, drowsiness, sedation, confusion). Other side effects - possible SJS, leukopenia, hyponatremia, aplastic anemia, thrombocytopenia, agranulocytosis, elevation of liver enzymes and hepatitis, TERATOGENIC 2) significant drug interactions with other drugs metabolized by P450 pathways, including inducing its own metabolism through autoinduction 3) Tox: confusion, stupor, motor restlessness, ataxia, tremor, nystagmus, twitching, vomiting.
Tiagabine and topiramate brand names?
Gabitril and topamax
Tiagabine and topiramate - what kind of drugs are they (Broad class) and what are they used for in psych?
Anti convuslant. Tiagabine - anxiety. Topamax - impulse control disorder/ anxiety. Beneficial side effect is weight loss, can cause hypochloremic, non-anion gap metabolic acidosis and kidney stones.limiting side effect - cognitive slowing.
What are the major side effects of the anticonvulsants used in psych
Weight gain, GI side effects, pancreatitis, sedation, alopecia, hepatotoxicity or benign aminotransferase eleations, thrmobocytopenia, teratognenic effects during pregnancy
What are the indications for use of anxiolytics/hypnotics?
Anxiety disorders, muscle spasms, seizures, sleep disorders, alcohol withdrawal, anethesia induction
What is the MOA for benzos?
Potentiate the effect of GABA.
What do benzos do
They reduce anxiety
What are the major benzos that are not metabolized by liver?
a LOT of them - lorazepam, oxazepam, temazepam
What are the long acting benzos, what is their half life
Diazepam (valium), clonazepam (klonopin)
What are valium and klonopin used for?
Valium: has rapid onset, used for alcohol detox/sedative hypnotic anxioloytics and for seizures. Not so much for anxiety anymore (including panic attacks). Klonopin used for anxiety. Long half life -> single daily dose
Avoid using klonopin in patients with?
Renal dysfunction
