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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
Q

Valproic acid can increase levels of drugs metabolized by ____

A

Valproic acid can increase levels of drugs metabolized by hepatic CYP450 enzymes

(check CBC and LFTs regularly when using valproic acid)

26
Q

Carbamazepine is used as a mood stabilizer for ____ and is more effective for ____ than for ____

A

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
Q

Carbamazepine induces ____, decreasing levels of ____, ____, and ____

A

Carbamazepine induces CYP450, decreasing levels of oral contraceptives, warfarin, and other anticonvulsants

(check CBC, LFTs, chem-7 and can monitor serum CBZ levels)

28
Q

Oxcarbazepine has effects similar to ____ with less severe side effects, fewer drug interactions, and less need for lab monitoring

A

Oxcarbazepine has effects similar to carbamazepine with less severe side effects, fewer drug interactions, and less need for lab monitoring

(mood stabilizer)

29
Q

Lamotrigine is used as a mood stabilizer for ____ and ____ but is not effective for ____

A

Lamotrigine is used as a mood stabilizer for maintenance treatment and bipolar depression but is not effective for acute mania

30
Q

Levels of lamotrigine can be reduced by ____

A

Levels of lamotrigine can be reduced by CYP450 inducers

31
Q

Lamotrigine metabolism is inhibited by ____

A

Lamotrigine metabolism is inhibited by valproic acid

32
Q

____ is a severe side effect of lamotrigine

A

Stevens-Johnson syndrome is a severe side effect of lamotrigine

33
Q

____ have mood stabilizing properties and are being used to treat bipolar disorder

A

Antipsychotics have mood stabilizing properties and are being used to treat bipolar disorder

34
Q

_____ antipsychotics may be used as mood stabilizers to treat bipolar disorder, bipolar depression, and maintenance treatment

A

Antipsychotics antipsychotics may be used as mood stabilizers to treat bipolar disorder, bipolar depression, and maintenance treatment

Psychiatry (37 decks)

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