Pharmacology Specifics – Mood Stabilizers Flashcards
What’s the name of the most well-known mood stabilizer?
Lithium
Depakote
Valproate
Lamictal
Lamotrigine
Tegretol
Carbamazepine
Trileptal
Oxcarbazepine
It is proposed that lithium has several mechanisms of action. What is its proposed impact on serotonin and serotonin receptors?
It is proposed that it can decrease presynaptic serotonin reuptake and increase postsynaptic serotonin receptor sensitivity
What type of cellular signaling does lithium effect?
G-protein signaling
Is proposed that lithium can decrease inositol production by inhibiting what enzyme?
Inositol monophosphatase
What other enzyme is it proposed that lithium can also inhibit?
Glycogen synthase kinase 3b
Aside from glycogen synthase kinase 3b and inositol monophosphatase, what other enzyme has lithium been shown to affect?
Adenylyl cyclase
Valproate, Lamotrigine, carbamazepine, and oxcarbazepine are collectively known as what medication class? What is their primary mechanism of action?
Anticonvulsants
They primarily reduce the excitatory potential of neurons
What are the two FDA approved indications for mood stabilizers?
Bipolar disorder & major depressive disorder (adjunctive therapy)
What is the one non-FDA approved use of mood stabilizers?
Anxiety
What cardiovascular irregularities are known adverse drug reactions associated with lithium?
AV block
bradycardia
flattened or inverted T waves
Aside from cardiovascular irregularities, what are three other well-known adverse drug reactions associated with lithium?
Hypothyroidism
hyperparathyroidism
nephrotoxicity
What are four well-known adverse drug reactions associated with the use of anticonvulsants?
Hyponatremia/SIADH-like syndrome
thrombocytopenia
hyperammonemia
rash (Stevens-Johnson syndrome)
What class of medication is used to prevent mood episodes in patients with bipolar disorder?
Mood stabilizers
What should a physician think about if a patient taking lithium is also taking ace inhibitors or angiotensin receptor blockers?
Levels of lithium will increase
Physician should monitor lithium levels and adjust dose as needed
What may happen if a patient taking carbamazepine (Tegretol) is also taking aripiprazole (Abilify)?
The levels of aripiprazole may be reduced
double the dose of aripiprazole in these patients
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?
There may be reduced efficacy of the birth control resulting in breakthrough bleeding and pregnancy
Physician should recommend a non-hormonal form of contraception
What may happen for a patient whose taking Lamotrigine and birth control hormones at the same time?
The levels of Lamotrigine may be reduced
Therefore, avoid use. If necessary, consider supplemental anticonvulsant/mood stabilizer coverage
What may happen if a patient is taking carbamazepine or Lamotrigine at the same time as hydrocodone (Lortab)?
It may increase sedative/CNS depressant effects
reduce hydrocodone dose approximately 25%
What may happen if a patient is taking carbamazepine and isoniazid at the same time?
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
What may happen if a patient is taking carbamazepine and Itraconazole (Sporanox) at the same time?
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
What may happen if a patient is taking valproate Lamotrigine together?
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
