Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psych clerkship > Mood Stabilizers > Flashcards

Mood Stabilizers Flashcards

1
Q

Which class of over the counter drug can decrease lithium excretion and thereby increase lithium concentrations?

A

NSAIDS (except sulindac and aspirin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the indications for lithium?

A
  • Acute mania

- Bipolar maintenance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What mood stabilizer is demonstrated to reduce suicidality?

A

Li+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What mood stabilizer has proven to be effective prophylaxis in majority of bipolar patients?

A

Li+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Li+ less effective in treating?

A

Less effective in rapid cycling or mixed bipolar states

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What baseline labs need to be done before starting Li+?

A

Get baseline Creatinine, BUN, TSH, and CBC ( every 6 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What teratogenic effect may Li+ have?

A

First trimester associated with Ebstein’s anomaly (RV hypoplasia & Tricuspid insufficiency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the major side effects of Li+?

A
  • Diarrhea, irritability, fine tremor, weight gain, nausea, hair loss, acne
  • Nephrogenic DI (polyuria/polydipsia) secondary to ADH antagonism
  • Coarse tremor, gait instability, vomiting, diarrhea, confusion, cognitive slowing, seizures, oliguria, and renal failure
  • Alopecia
  • Metallic taste
  • Women are at greater risk of thyroid dysfunction secondary to Li+
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What conditions can increase the risk of Li+ toxicity?

A

Increased risk of toxicity with:

  • Fluid or salt restriction
  • Hot weather/sweating
  • Use of anti-inflammatory drugs (except Aspirin)
  • ACE-I/ARBs
  • Thiazide diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In what ways is valproic acid more effective than Li+?

A
  • More effective than lithium in rapid cycling & mixed states
  • Can treat aggression and impulsivity in other psychiatric disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In what ways is valproic acid not as effective as Li+?

A
  • As effective as Lithium in mania prophylaxis but is not as effective in depression prophylaxis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What baseline tests should be taken before starting valproic acid?

A

Before med is started: baseline liver function tests (LFT), pregnancy test, and CBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is steady state achieved for Li+ , Carbamazepine, and Valproic acid and what should be done after it is achieved?

A
  • Steady state achieved after 4-5 days
  • Valproic Acid => check 12 hours after last dose and repeat CBC and LFTs
  • Lithium => check TSH and Creatinine
  • Carbamazepine => CBC and LFTs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the target blood levels for Li+, Carbamazepine, and Valproic acid?

A

Lithium : 0.8-1.2
Carbamazepine: 8-12
Valproic Acid: 80-120

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the major side effects of Valproic Acid?

A
  • Nausea, weight gain, sedation, unsteadiness (ataxia), hair loss, tremor
  • Liver dysfunction/hepatic failure, decreased platelets (thrombocytopenia)
  • Acute pancreatitis
  • Hyperammonemia
  • Neural tube defects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the use of Carbamazepine as a mood stabilizer?

A

Utility falls somewhere between Li+ and Valproic Acid

17
Q

What tests should be done before Carbamazepine is started?

A

Baseline liver function tests (LFTs), CBC, and EKG

18
Q

What are the major side effects of Carbamazepine?

A
  • Agranulocytosis (also with clozapine)
  • Aplastic anemia
  • SIADH
19
Q

What are the GI effects of Carbamazepine?

A

GI: nausea, constipation, diarrhea, appetite loss

20
Q

What are the CNS effects of Carbamazepine?

A

CNS: sedation, dizziness, unsteadiness, confusion

21
Q

What are the dermatological effects of Carbamazepine?

A

Dermatology - benign rashes common, catastrophic rashes (TEN, SJS) rare

22
Q

What are the cardiac effects of carbamazepine?

A

AV conduction delays

23
Q

What is special about the metabolism of carbamazepine?

A
  • p450 inducer

- induces its own metabolism

24
Q

What is lamotrigine/lamictal particularly good at treating?

A

Appears to be especially effective in tx of bipolar depression and maintenance treatment of bipolar; unproven to treat mania

25
Q

Why must lamotrigine be increased slowly?

A

Slow increase in dosage will decrease risk of steven johnson’s syndrome

26
Q

What effect does valproic acid and carbamazepine have on lamotrigine?

A

Valproic acid - increases lamotrigine levels

Carbamazepine - decreases lamotrigine levels

27
Q

Why are antidepressants discouraged as monotherapy for bipolar disorder?

A

Concerns of activating mania or hypomania

28
Q

When is ECT indicated in the treatment of bipolar disorder?

A

ECT works well in the treatment of manic episodes (usually requires more treatments than depression)

29
Q

How should a patient with a history of postpartum mania be treated?

A
  • Antidepressants and Li+ in subsequent pregnancies as prophylaxis
  • HOWEVER, these are contraindications to breast feeding

Psych clerkship (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions