Therapeutics of Mood Stabilizers Flashcards
What is mania, hypomania
Mania is an abnormal and persistent elevated mood lasting for AT LEAST ONE WEEK while hyomania is less severe and only lasting at least FOUR DAYS
What is rapid cycling
GREATER THAN 4 mood epsisodes in 12 months
What are characteristics of Bipolar Disorder 1
BD1 involves episodes of mania, major depression, and mixed features (best characterized by mania)
What are characteristics of Bipolar Disorder 2
BD2 involves hypomania, major depression and mixed features (best characterized by its depression)
T/F: Bipolar disorder can be diagnosed following a sing visit
False: Bipolar disorder should never be diagnosed following a single visit
What is the mean age of onset of BD1,BD2
18 years, mid-20s
What medications are potential causes of mania
Antidepressants (SSRI, MAOI, TCA), steroids, amphetamines, Bronchodilators (ephedrine, albuterol, theophylline)
What is the first line for a MANIC EPISODE
Lithium, valproate, or SGA (quetiapine, asenapine, aripiprazole, paliperidone, risperidone, cariprazine, Or a combination SGA AND lithium or valproate
In Bipolar 1 depression what drugs should be used with caution
Antidressants (SSRIs and SNRIs), associate with manic switch
What is the first line treatment for Bipolar 1 depression
Quetiapine, lithium, lamotrigine, lurasidone/ Lurasiodne PLUS lamotriginem, Quetiapine PLUS lithium, can add on valproate
What are the kinetics of lithium, how is it metabolized
1st order kinetics (double the dose double the concentration), excreted by the kidneys
T/F: EVeryone exretes lithium the same
False: Manic patients exretes lithium faster than normal patients, so as patients get better the drug is not excreted as quickly
What is the normal dose of lithium, what is the blood level desired for acute mania, maintenance
1500-2000 mg/day, 0.8-1.2, 0.6-0.9
How long should it take for lithium be therapeutic when first started, when changing the dose
21 days, 4-5 days
What is the most common side effect of lithium, how is it managed
Nausea/vomiting/GI pain (33%), usually transient but can also take with food in divided doses OR switch to sustain release preparation
What is the side effect of lithium that effects 6-20% of patients, treatment
Diarrhea, immediate release preparation or liquid form
What are the more severe side effects of lithium
Leukocytosis (increase WBCs by 30-40%), thrombocytosis (increased platelets), tremor, polydipsia/poluria, weight gain
How is tremor treated do to lithium
Decrease dose or low dose beta-blocker (propanolol)
What are drug interatctions of lithium causing what
Diuretics, ACEI, and NSAIDS, increase lithium level
What lithium level is known as mild, moderate, and severe
1.2 - 2.5 mEq/L, 2.0-3.0 mEq/L, greater than 3.0 mEq/L
What factors that will reduce lithium clearance
Low sodium intake, extra sodium loss, renal impairment, being old
T/F: Lithium is not recommended in pregnant patients
True
What drugs increase lithium clearance
Caffeine and theophylie
What drug drug interactions cause nephrotoxicity when used with lithium
Carbamazepine and Antipsychotics (mostly FGAs)
What is the only test that do not be made when a person is started on lithium
Liver tests
How is valporic acid metabolized
Glucorondidation through the liver
What is the therapeutic trial for using valproic acid to treat mania
21 days
What is the BBW of valproic acid
Heptaotxicity, Teratogenicity, Pancreatitis
What are the adverse effects of valrpoic acid
Headaches, dizzines, N/V, weight gain , alopeciathrombocytopenia and neutropenia
How should the dose of VPA change if switching from IR to ER
The dose will need to increase by 8-20%
What enzyme does VPA inhibit
Phenytoin
What is the target dose for lamotrigine, what is it used for
200 mg/day, maintenance for manic or depressed mood episodes
What is the BBW for lamotrigine
Rash (SSJ)
What are the common ADRs at high doses
Diplopia (double vision) and dizziness
What are the lamotrigine drug interactions and what happens
Valproic acid: decrase clearance due to competition for hepatic metabolism, estrogen: increase clearance of lamotrigine
What is the starting dose for carbamezapine being used to treat mania, maintenance range, therapeutic trial
200 mg BID, 400-1200 mg/day, 21 days
T/F: Lamotrogine can be used in manic episodes
False: Lamotrigine needs to be titrated to the target dose so it will never be used to treat acute episodes
What is the BBW of carbamazepine
Aplastic anemia, agranuloocytosis risk, skin rash in patients with HLA-B 1502 allele (Asians)
