SM_107b: Mood Stabilizers Flashcards
Mood stabilizer acts by ____, ____, and ____
Mood stabilizer acts by treating manic episodes, treating depressive episodes without precipitating mania, and preventing manic and depressive episodes
In contrast to mood stabilizers, antidepressants ____ and ____
In contrast to mood stabilizers, antidepressants do not treat manic episodes and can precipitate mania in patients with bipolar disorder
Mood stabilizers likely act by ____ and ____
Mood stabilizers likely act by decreasing activity of excitatory neurotransmitters (glutamate) and increasing activity of inhibitory neurotransmitters (GABA)
Mood stabilizers include ____, ____, and ____
Mood stabilizers include lithium, anticonvulsants, and antipsychotics
Describe mechanism of lithium
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)
Therapeutic level of lithium is _____
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
Side effects of lithium involve ____, ____, ____, ____, ____, and ____
Side effects of lithium involve renal, nervous system, endocrine, cardiac, GI, and others
Describe renal side effects of lithium
Renal side effects of lithium
- Polyuria and polydipsia
- Nephrogenic diabetes insipidus
- Interestitial nephritis and impaired glomerular function with chronic use
- Renal insufficiency (rare)
Describe CNS side effects of lithium
Lithium CNS side effects
- Sedation
- Impaired cognition
- Tremor (can be treated with propranolol)
- Ataxia and dysarthria
_____ can be used to treat tremor caused by lithium
Propranolol can be used to treat tremor caused by lithium
Common endocrine side effect of lithium is ____
Common endocrine side effect of lithium is hypothyroidism
(also euthyroid goiter and subclinical hypothyroidism)
Cardiac side effects of lithium are ____
Cardiac side effects of lithium are cardiac conduction problems
(sinus bradycardia, SA blockade, AV blockade, and ventricular irritability)
Describe GI side effects of lithium
Lithium GI side effects
- Increased appetite and weight gain
- Upset stomach
- Nausea, vomiting, diarrhea
Lithium use during pregnancy may cause ____
Lithium use during pregnancy may cause Ebstein’s anomaly (dysplastic tricuspid valve)
Describe drugs that increase serum lithium levels
Drugs that increase serum lithium levels
- NSAIDs
- Thiazides
- Spironolactone
- Triamterene
- ACE-i
- Ca channel blockers
- Metronidazole
- Tetracycline
Describe drugs that decrease lithium levels
Drugs that decrease lithium levels
- Acetazolamide
- Alkalizing agents
Patients with severe lithium toxicity are at risk for ____, ____, and ____
Patients with severe lithium toxicity are at risk for permanent neurologic damage, permanent renal damage, and death
Lithium toxicity presents with ____, ____, ____, and ____
Lithium toxicity presents with neurologic, GI, renal, and cardiovascular symptoms
If rapid effect is important, do NOT use the mood stabilizer ______
If rapid effect is important, do NOT use the mood stabilizer lithium
Lithium acts via ____
Lithium acts via intracellular signal transduction systems
Lithium has ____ excretion
Lithium has renal excretion
Anticonvulsants act by ____ to ____ and ____ just like lithium
Anticonvulsants act by blocking voltage-gated ion channels to enhance activity of GABA and/or decrease activity of glutamate just like lithium
Anticonvulsants commonly used as mood stabilizers include ____, ____, ____, and ____
Anticonvulsants commonly used as mood stabilizers include valproic acid, carbamazepine, oxcarbazepine, and lamotrigine
Describe use of valproic acid as a mood stabilizer
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
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)
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
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)
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)
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
Levels of lamotrigine can be reduced by ____
Levels of lamotrigine can be reduced by CYP450 inducers
Lamotrigine metabolism is inhibited by ____
Lamotrigine metabolism is inhibited by valproic acid
____ is a severe side effect of lamotrigine
Stevens-Johnson syndrome is a severe side effect of lamotrigine
____ 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
_____ 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
