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Psychiatry > SM_107b: Mood Stabilizers > Flashcards

SM_107b: Mood Stabilizers Flashcards

1
Q

Mood stabilizer acts by ____, ____, and ____

A

Mood stabilizer acts by treating manic episodes, treating depressive episodes without precipitating mania, and preventing manic and depressive episodes

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2
Q

In contrast to mood stabilizers, antidepressants ____ and ____

A

In contrast to mood stabilizers, antidepressants do not treat manic episodes and can precipitate mania in patients with bipolar disorder

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3
Q

Mood stabilizers likely act by ____ and ____

A

Mood stabilizers likely act by decreasing activity of excitatory neurotransmitters (glutamate) and increasing activity of inhibitory neurotransmitters (GABA)

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4
Q

Mood stabilizers include ____, ____, and ____

A

Mood stabilizers include lithium, anticonvulsants, and antipsychotics

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5
Q

Describe mechanism of lithium

A

Mechanism of lithium

  • Acts via intracellular signal transduction systems
  • Alters activity of several neurotransmitters
  • Inhibits inositol monophosphate
  • Decreases PKC activity
  • Uncouples receptors from G proteins
  • Inhibits glycogen synthase kinase-3

(not well understood, no direct action at synapses)

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6
Q

Therapeutic level of lithium is _____

A

Therapeutic level of lithium is 0.6-1.2 mEq/L

  • Check 5 days after any dose change
  • Get serum level 12 hours after last dose
  • Level of 1.0 mEq/L is ideal especially for patients with mania
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7
Q

Side effects of lithium involve ____, ____, ____, ____, ____, and ____

A

Side effects of lithium involve renal, nervous system, endocrine, cardiac, GI, and others

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8
Q

Describe renal side effects of lithium

A

Renal side effects of lithium

  • Polyuria and polydipsia
  • Nephrogenic diabetes insipidus
  • Interestitial nephritis and impaired glomerular function with chronic use
  • Renal insufficiency (rare)
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9
Q

Describe CNS side effects of lithium

A

Lithium CNS side effects

  • Sedation
  • Impaired cognition
  • Tremor (can be treated with propranolol)
  • Ataxia and dysarthria
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10
Q

_____ can be used to treat tremor caused by lithium

A

Propranolol can be used to treat tremor caused by lithium

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11
Q

Common endocrine side effect of lithium is ____

A

Common endocrine side effect of lithium is hypothyroidism

(also euthyroid goiter and subclinical hypothyroidism)

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12
Q

Cardiac side effects of lithium are ____

A

Cardiac side effects of lithium are cardiac conduction problems

(sinus bradycardia, SA blockade, AV blockade, and ventricular irritability)

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13
Q

Describe GI side effects of lithium

A

Lithium GI side effects

  • Increased appetite and weight gain
  • Upset stomach
  • Nausea, vomiting, diarrhea
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14
Q

Lithium use during pregnancy may cause ____

A

Lithium use during pregnancy may cause Ebstein’s anomaly (dysplastic tricuspid valve)

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15
Q

Describe drugs that increase serum lithium levels

A

Drugs that increase serum lithium levels

  • NSAIDs
  • Thiazides
  • Spironolactone
  • Triamterene
  • ACE-i
  • Ca channel blockers
  • Metronidazole
  • Tetracycline
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16
Q

Describe drugs that decrease lithium levels

A

Drugs that decrease lithium levels

  • Acetazolamide
  • Alkalizing agents
17
Q

Patients with severe lithium toxicity are at risk for ____, ____, and ____

A

Patients with severe lithium toxicity are at risk for permanent neurologic damage, permanent renal damage, and death

18
Q

Lithium toxicity presents with ____, ____, ____, and ____

A

Lithium toxicity presents with neurologic, GI, renal, and cardiovascular symptoms

19
Q

If rapid effect is important, do NOT use the mood stabilizer ______

A

If rapid effect is important, do NOT use the mood stabilizer lithium

20
Q

Lithium acts via ____

A

Lithium acts via intracellular signal transduction systems

21
Q

Lithium has ____ excretion

A

Lithium has renal excretion

22
Q

Anticonvulsants act by ____ to ____ and ____ just like lithium

A

Anticonvulsants act by blocking voltage-gated ion channels to enhance activity of GABA and/or decrease activity of glutamate just like lithium

23
Q

Anticonvulsants commonly used as mood stabilizers include ____, ____, ____, and ____

A

Anticonvulsants commonly used as mood stabilizers include valproic acid, carbamazepine, oxcarbazepine, and lamotrigine

24
Q

Describe use of valproic acid as a mood stabilizer

A

Use of valproic acid as a mood stabilizer

  • Very effective for acute mania and maintenance treatment
  • More effective for acute mania than lithium
  • Works more quickly than lithium for mania
  • Less effective for bipolar depression than lithium
25
Valproic acid can increase levels of drugs metabolized by \_\_\_\_
Valproic acid can increase levels of drugs metabolized by hepatic CYP450 enzymes (check CBC and LFTs regularly when using valproic acid)
26
Carbamazepine is used as a mood stabilizer for ____ and is more effective for ____ than for \_\_\_\_
Carbamazepine is used as a mood stabilizer for acute mood episodes and maintenance and is more effective for manic / mixed episodes than for depression
27
Carbamazepine induces \_\_\_\_, decreasing levels of \_\_\_\_, \_\_\_\_, and \_\_\_\_
Carbamazepine induces CYP450, decreasing levels of oral contraceptives, warfarin, and other anticonvulsants (check CBC, LFTs, chem-7 and can monitor serum CBZ levels)
28
Oxcarbazepine has effects similar to ____ with less severe side effects, fewer drug interactions, and less need for lab monitoring
Oxcarbazepine has effects similar to carbamazepine with less severe side effects, fewer drug interactions, and less need for lab monitoring (mood stabilizer)
29
Lamotrigine is used as a mood stabilizer for ____ and ____ but is not effective for \_\_\_\_
Lamotrigine is used as a mood stabilizer for maintenance treatment and bipolar depression but is not effective for acute mania
30
Levels of lamotrigine can be reduced by \_\_\_\_
Levels of lamotrigine can be reduced by CYP450 inducers
31
Lamotrigine metabolism is inhibited by \_\_\_\_
Lamotrigine metabolism is inhibited by valproic acid
32
\_\_\_\_ is a severe side effect of lamotrigine
Stevens-Johnson syndrome is a severe side effect of lamotrigine
33
\_\_\_\_ have mood stabilizing properties and are being used to treat bipolar disorder
Antipsychotics have mood stabilizing properties and are being used to treat bipolar disorder
34
\_\_\_\_\_ antipsychotics may be used as mood stabilizers to treat bipolar disorder, bipolar depression, and maintenance treatment
Antipsychotics antipsychotics may be used as mood stabilizers to treat bipolar disorder, bipolar depression, and maintenance treatment

Psychiatry (37 decks)

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