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Psychopharmacology > Synopsis mood stabilizers > Flashcards

Synopsis mood stabilizers Flashcards

1
Q

how long to peak serum concentration for lithium

A

1-1.5 hours for standard
4-4.5 hours for ER

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2
Q

elimination half-life of lithium

A

18-24 hours

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3
Q

how if lithium metabolized and excreted

A

it is not metabolized. It is excreted through kidneys

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4
Q

therapeutic indications for lithium

A

-mania
-bipolar depression
-bipolar maintenance
-MDD
-schizoaffective disorder
0schizophrenia

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5
Q

Lithium onset when treating mania

A

typically slow. Exerts effect over 1-3 weeks

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6
Q

how do you treat the manic patient in the short term who has been initiated on lithium therapy

A

give benzodiazepine, DRA, SDA, or valproic acid as well for first few weeks

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7
Q

what should you connsider if a depressive episode occurs in a patient taking lithium

A

lithium-induced hypothyroidism
substance abuse
noncompliance

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8
Q

use of lithium in schizoaffective disorder and schizophrenia

A

-prominent mood sx more likely to respond than prominent psychotic symptoms
-useful for augmenting antipsychotics

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9
Q

Lithium in MDD

A

no more effective than other antidepressants for monotherapy. Usually used as adjunct in nonresponders

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10
Q

what is sodium’s effect on lithium levels

A

excessive intake lowers levels
hyponatremia causes toxicity
dehydration can cause intoxication

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11
Q

cardiac side effects of lithium

A

bradycardia and arrythmias

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12
Q

how can you decrease GI upset of lithium

A

take with food

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13
Q

does lithium cause weight gain? Why or why not?

A

yes d/t effects on carbohydrate metabolism
OR
d/t lithium-induced:
hypothyroidism
edema
thirst causing increased intake of soda

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14
Q

neuro side effects of lithium

A

tremor
cognitive effects

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15
Q

what can reduce lithium-induced tremor

A

propranolol 30-120mg daily (divided)
primidone 50-250mg daily

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16
Q

renal side effects of lithium

A

polyuria (if severe eval renal function)
polydipsia

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17
Q

thyroid side effects of lithium

A

goiter, hyperthyroidism, hypothyroidism

Monitor TSH q6 months

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18
Q

what places someone at a higher risk of cardiac side effects from lithium

A

low salt diet
diuretics/ACEIs
fluid/electrolyte imbalance
renal insufficiency

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19
Q

what are some dermatologic side effects of lithium

A

worsening of psoriasis
alopecia

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20
Q

early signs of lithium OD/toxicity

A

tremor
dysarthria
ataxia
GI sx
cardio changes
renal dysfunction

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21
Q

what are later signs of lithium OD/toxicity

A

loss of consciousness
muscular fasciculations
myoclonus
seizures
coma

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22
Q

how can lithium be removed from the body

A

kayexalate and miralax but not activated charcoal (GI tract)
hemodialysis

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23
Q

lithium and pregnancy

A

contraindicated during first trimester d/t risk of birth defects

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24
Q

most common birth defect associated with lithium

A

Ebstein anomaly

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25
Q

what are some drugs that increase lithium concentrations

A

carbamazepine, lamotrigine, valproate, clonazepam, thiazide/K-sparing diuretics, ACEIs, NSAIDs

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26
Q

what are some drugs that decrease concentration of lithium

A

osmotic/loop diuretics, carbonic anhydrase inhibitors, xanthines

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27
Q

can you combine calcium channel blockers with Lithium? Why?

A

No because of risk of fatal neurotoxicity

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28
Q

how many days prior to ECT must lithium be discontinued

A

2 days to decrease risk of delirium

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29
Q

starting dose of lithium

A

300mg TID

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30
Q

labs prior to starting lithium

A

creatinine, electrolytes, thyroid function tests, CBC, ECG, pregnancy test

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31
Q

how often should lithium levels be checked

A

every 2-6 months
weekly if dose adjustment. s/s toxicity, suspected noncompliance

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32
Q

how often should ECG be obtained with lithium

A

annually

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33
Q

effective lithium serum concentration for mania treatment

A

1-1.2 (associated w/ 1800mg daily)

34
Q

effective serum concentration of lithium for maintenance

A

0.4-0.8 (associated w/ 900-1200mg daily)

35
Q

therapeutic indications for valproate

A

-bipolar 1 (mania, depression, maintenance)
-schizophrenia
-schizoaffective disorder

35
Q

what is the black box warning attached to valproate

A

pancreas and liver dysfunction

36
Q

symptoms of severe hepatotoxicity with valproate

A

lethargy
malaise
anorexia
N/V
edema
abdominal pain

37
Q

what fetal abnormalities are associated with valproate

A

spina bifida (give folic acid)
heart malformations

38
Q

weight gain with valproate

A

common

39
Q

what drugs can be safely combined with valproate

A

serotonin-dopamine antagonists and carbamazepine

40
Q

can you give valproate with lamotrigine? why?

A

no because of increased risk of steven Johnson syndrome

41
Q

baseline line labs before starting valproate

A

hepatic panel. CBC, platelet count, pregnancy test

42
Q

how often should hepatic transaminase be monitored with valproate

A

one month after starting therapy then every 6-24 months

43
Q

therapeutic indications for lamotrigine

A

bipolar maintenance

44
Q

major side effect of lamotrigine

A

steven johnson syndrome (report rash)

45
Q

what drugs decrease concentration of lamotrigine

A

carbamazepine
phenytoin
phenobarbital

46
Q

what if 4+ days of lamotrigine are missed

A

must start at begining and titrate up again

47
Q

dosage of lamotrigine for bipolat

A

100-200mg daily

48
Q

how long is taper to dc lamotrigine

A

over 2 weeks, unless rash develops then dc over 1-2 days

49
Q

half-life of carbamazepine

A

18-54 hours (average 26)

50
Q

what happens to carbamazepine’s half-life w/ chronic use (after 3-5 weeks)

A

it decreases to 12 hours

51
Q

therapeutic indications for carbamazepine

A

acute mania
prophylaxis
acute depression

52
Q

what are some common augmentation meds used with carbamazepine

A

lithium
valproate
thyroid hormones
antipsychotics

53
Q

how fast is response usually seen to carbamazepine when using for acute mania

A

within the first several days of treatment

54
Q

what are some common side effects of carbamazepine

A

GI side effects, ataxia, drowsiness

55
Q

what are some serious side effects of carbamazepine

A

blood dyscrasias
hepatitis
steven johnson syndrome
renal side effects

56
Q

what medication should always be coadministered with carbamazepine to women and why

A

folic acid because of the risk of neural tube defects in pregnancy

57
Q

major drug interactions for carbamazepine

A

-decrease concentration of oral contraceptives
-contraindicated w/ MAOIs
-grapefruit juice inhibits metabolism

58
Q

coadministration of carbamazepine and valproate

A

valproate displaces carbamazepine so may need to decrease dose and increase dose of valproate

59
Q

carbamazepine lab interferences

A

cause decreased TSH
increase total cholesterol

60
Q

carbamazepine dosage for mania

A

1200mg daily

61
Q

dosing carbamazepine with meal

A

absorption is faster when taken with high-fat meal

62
Q

contraindications to carbamazepine

A

preexisting hematologic, hepatic, and cardiac diseases

63
Q

dosage of carbamazepine with hepatic impairment

A

1/3 - 1/2 the dose

64
Q

baseline labs for carbamazepine

A

CBC w/ platelets
LFTs
electrolytes
EEG (if>40 or w/ preexisting condition)

65
Q

how often do you monitor labs with carbamazepine

A

q2 weeks x2 months then quarterly

66
Q

half life of oxcarbazepine

A

the parent compound is 2 hours but metabolite (monohydroxide) is 9 hours

67
Q

most common side effects of oxcarbazepine

A

sedation and nausea

68
Q

carbamazepine v/ oxcarbazepine side effects

A

oxcarbazepine more likely to cause hyponatremia but less likely to develop serious rash

69
Q

metabolism of oxcarbazepine and drug interactions

A

-oxcarbazepine induces 3A4 and inhibits 2C19
-3A4 inducers increase clearance and decrease concentration (phenobarbital, alcohol)

70
Q

excretion of gabapentin

A

excreted renally unchanged and can be removed by hemodialysis

71
Q

therapeutic indications for gabapentin

A

seizures
neuropathic pain
can help w/ social anxiety/panic disorder

72
Q

what labs will gabapentin create false positives of

A

amphetamines, barbiturates, benzodiazepines, marijuana

73
Q

therapeutic indications for topirimate

A

migraine prevention
obesity
bulimia
binge-eating
alcohol dependence

74
Q

most common side effects of topiramate

A

paresthesia
weight loss
somnolence
anorexia
dizziness
memory problems

75
Q

what drugs do topiramate increase the concentration of

A

phenytoin
valproic acid

76
Q

what drugs decreases concentration of topiramate

A

carbamazepine and phenytoin

77
Q

what are some off-label uses for levetiracetam

A

acute mania
adjunct w/ antidepressant
anxiolytic

78
Q

psych indications for phenytoin

A

bipolar mania

79
Q

what is considered second-line treatment for acute mania

A

calcium channel blockers

Psychopharmacology (14 decks)

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