xx. Mood Stabilizers

Question 1

what are mood stabilizers used for?

Answer 1

to prevent the extreme mood swings between mania and depression, typical of bipolar disorder.

Question 2

what is the classic mood stabilizer?

Answer 2

lithium

Question 3

what are anti-convulsants that are used for mood stabilizing?

Answer 3

valproate, carbamazepine, lamotrigine, oxcarbazepine

Question 4

what is an anti-psychotic used as a mood stabilizer?

Answer 4

olanzapine

Question 5

one problem with lithium?

Answer 5

narrow therapeutic range, must be monitored

Question 6

what is lithium sensitive to?

Answer 6

volume of distribution is same as body water; anything that changes body water can cause toxic incr in lithium levels.

Question 7

side effects of lithium?

Answer 7

ataxia, lethargy, wt gain

Question 8

olanzapine used at what point of bipolar treatment?

Answer 8

at the start, if treating with lithium or valproic acid. the half lives of those are long, can take days to get effect.

Question 9

olanzapine also approved as what?

Answer 9

monotherapy for mania

Question 10

valproate: class? mech? warnings?

Answer 10

anti-convulsant, mood stabilizer. increases GABA effects. hepatotoxic, teratogen, pancreatitis

Question 11

carbamazepine: class? mech? warnings?

Answer 11

anti-convulsant, mood stabilizer. Blocks Na channels. effects activity of other drugs, can have derm reactions

Question 12

lamotrigine: class? mech? warnings?

Answer 12

anticonvulsant, mood stabilizer. blocks Na channels. Serious skin rashes.

Question 13

oxcarbazepine: class? mech? warnings?

Answer 13

anticonvulsant, mood stabilizer. blocks Na channels. more expensive than carbamazepine.

Question 14

olanzapine: class? mech? warnings?

Answer 14

atypical antipsychotic, mood stabilizer.
Blocks 5HT2A and D2 receptors.
QT prolongation, not for dementia-related psychosis, not for elderly dementia pts

Question 15

preferred bipolar med for pregnancy?

Answer 15

olanzapine

Question 16

management of acutely manic patient?

Answer 16

start on olanzapine: rapid onset. mood stabilizer to manage the condition long-term (lithium, valproate, lamotrigine)

Question 17

longer-term management of a bipolar patient?

Answer 17

taper off atypical antipsychotic once acute mania has worn off and mood stabilizer has reached steady state.

Question 18

what can anti-depressants do in bipolar patients?

Answer 18

monotherapy with antidepressants can induce mania

Question 19

what do many people with bipolar take?

Answer 19

a mood stabilizer combined with an antidepressant.

Question 20

what are 2 things that can cause toxic levels of lithium?

Answer 20

running a marathon, diuretic (decr body water)

Question 21

what drug is best for acute management of manic patient?

Answer 21

olanzapine