Pharmacology Specifics – Mood Stabilizers

Question 1

What’s the name of the most well-known mood stabilizer?

Answer 1

Lithium

Question 2

Depakote

Answer 2

Valproate

Question 3

Lamictal

Answer 3

Lamotrigine

Question 4

Tegretol

Answer 4

Carbamazepine

Question 5

Trileptal

Answer 5

Oxcarbazepine

Question 6

It is proposed that lithium has several mechanisms of action. What is its proposed impact on serotonin and serotonin receptors?

Answer 6

It is proposed that it can decrease presynaptic serotonin reuptake and increase postsynaptic serotonin receptor sensitivity

Question 7

What type of cellular signaling does lithium effect?

Answer 7

G-protein signaling

Question 8

Is proposed that lithium can decrease inositol production by inhibiting what enzyme?

Answer 8

Inositol monophosphatase

Question 9

What other enzyme is it proposed that lithium can also inhibit?

Answer 9

Glycogen synthase kinase 3b

Question 10

Aside from glycogen synthase kinase 3b and inositol monophosphatase, what other enzyme has lithium been shown to affect?

Answer 10

Adenylyl cyclase

Question 11

Valproate, Lamotrigine, carbamazepine, and oxcarbazepine are collectively known as what medication class? What is their primary mechanism of action?

Answer 11

Anticonvulsants

They primarily reduce the excitatory potential of neurons

Question 12

What are the two FDA approved indications for mood stabilizers?

Answer 12

Bipolar disorder & major depressive disorder (adjunctive therapy)

Question 13

What is the one non-FDA approved use of mood stabilizers?

Answer 13

Anxiety

Question 14

What cardiovascular irregularities are known adverse drug reactions associated with lithium?

Answer 14

AV block

bradycardia

flattened or inverted T waves

Question 15

Aside from cardiovascular irregularities, what are three other well-known adverse drug reactions associated with lithium?

Answer 15

Hypothyroidism

hyperparathyroidism

nephrotoxicity

Question 16

What are four well-known adverse drug reactions associated with the use of anticonvulsants?

Answer 16

Hyponatremia/SIADH-like syndrome

thrombocytopenia

hyperammonemia

rash (Stevens-Johnson syndrome)

Question 17

What class of medication is used to prevent mood episodes in patients with bipolar disorder?

Answer 17

Mood stabilizers

Question 18

What should a physician think about if a patient taking lithium is also taking ace inhibitors or angiotensin receptor blockers?

Answer 18

Levels of lithium will increase

Physician should monitor lithium levels and adjust dose as needed

Question 19

What may happen if a patient taking carbamazepine (Tegretol) is also taking aripiprazole (Abilify)?

Answer 19

The levels of aripiprazole may be reduced

double the dose of aripiprazole in these patients

Question 20

For a patient who may be taking carbamazepine (Tegretol) or oxcarbazepine (Trileptal) while also taking birth control hormones… What may happen? Which should a physician recommend?

Answer 20

There may be reduced efficacy of the birth control resulting in breakthrough bleeding and pregnancy

Physician should recommend a non-hormonal form of contraception

Question 21

What may happen for a patient whose taking Lamotrigine and birth control hormones at the same time?

Answer 21

The levels of Lamotrigine may be reduced

Therefore, avoid use. If necessary, consider supplemental anticonvulsant/mood stabilizer coverage

Question 22

What may happen if a patient is taking carbamazepine or Lamotrigine at the same time as hydrocodone (Lortab)?

Answer 22

It may increase sedative/CNS depressant effects

reduce hydrocodone dose approximately 25%

Question 23

What may happen if a patient is taking carbamazepine and isoniazid at the same time?

Answer 23

The levels of carbamazepine may increase and lead to risk of isoniazid-associated hepatotoxicity

Avoid use; if necessary, monitor carbamazepine levels and liver function tests

Question 24

What may happen if a patient is taking carbamazepine and Itraconazole (Sporanox) at the same time?

Answer 24

Reduced levels of Itraconazole and increased levels of carbamazepine

Avoid concomitant use two weeks prior to and during my itraconazole therapy if necessary, monitor carbamazepine level and Itraconazole (lack of) effect. Adjust doses as needed

Question 25

What may happen if a patient is taking valproate Lamotrigine together?

Answer 25

Increased half-life of Lamotrigine and increased risk of Stevens-Johnson syndrome

Avoid use

If necessary, does cautiously:
Weeks 1 and 2: 25 mg of Lamotrigine every other day

Weeks 3 and 4: 25 mg of Lamotrigine once daily

Thereafter: increase Lamotrigine by 25-50 mg daily every 1-2 weeks to a target dose of 100-200 mg/day, given BID