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Year 3 - Psychiatry > Mood stabilisers > Flashcards

Mood stabilisers Flashcards

1
Q

What are the 3 classes of mood stabilisers?

A

Lithium
anticonvulsants
antipsychotics

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2
Q

What conditions can mood stabilisers treat?

A

Bipolar, cyclothma, schizoaffective

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3
Q

What medication is shown to reduce suicide rate?

A

Lithium

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4
Q

Lithium is effect in?

A

long-term prophylaxis of both mania and depressive episodes

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5
Q

What factors predict a positive response to lithium?

A

prior long-term response

  • family member with good response
  • classic pure mania
  • mania is followed by depression
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6
Q

What do you need to do before starting lithium?

A
  • get baseline U&E and TSH (can affect renal function and thyroid - hypo)
  • pregnancy tests
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7
Q

Lithium use in pregnancy is associated with which anomaly?

A

Ebstein’s - heart defect

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8
Q

How to monitor lithium use?

A

start at 400mg - check again after 5-7 days

  • check 12 hours after last dose
  • once stable check blood levels every 3 months (thyroid level)
  • TSH and creatine after 6 months
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9
Q

Ideal blood level for using lithium?

A

0.6-1.2

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10
Q

Lithium side effects?

A

GI distress - nausea, vomiting, diarrhoea

  • thyroid abnormalities
  • non-significant leukocytosis
  • polyuria/polydipsia secondary to ADH (can get intestinal renal fibrosis)
  • hair loss, acne
  • reduce seizure threshold, intention tremor!!
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11
Q

Lithium toxicity = mild, moderate and severe level and symptoms

A

mild = 1.5-2 = vomiting, ataxia, slurred speech, nystagmus

Moderate = 2-2.5 - anorexia, blurred vison, clonic limb movements, convulsions, delirium

Severe - >2.5
- generalised convulsions, oliguria and renal failure

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12
Q

Example of an anticonvulsant?

A

Valproic acid

- good for mania but not so much for depression

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13
Q

What factors contribute to a positive response using valproic acid?

A
  • rapid cycling patients F>M
  • comorbid substance issues (Alcohol)
  • mixed patients
  • patients with co-morbid anxiety disorders
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14
Q

Why do we tend to avoid lithium in those who consume alcohol?

A

can lead to dehydration due to toxicity

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15
Q

Tests before Valproic acid?

A

baseline LFTS

  • pregnancy test
  • FBC
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16
Q

Why do we avoid Valproic acid in pregnancy?

A

neural tube defects

17
Q

How do we monitor valproic acid?

A

steady stage achieved after 4-5 days

  • check 12 hours after last dose
  • repat CBC and lfts
18
Q

target goal of valproic acid?

A

50-125

19
Q

Valproic side effects?

A
  • thrombocytopenia and platelet dysfunction
  • nausea, vomiting
  • sedation , tremor
  • increased risk of NTD - reduction of folic acid
  • hair loss
20
Q

What is the first line agent for acute mania and mania prophylaxis?
- who is it indicated for?

A

Carbamazepine

- rapid cyclers and mixed patients

21
Q

Tests before starting Carbamazepine?

A

LFTS, FBC, ecg

22
Q

how do we monitor Carbamazepine?

A

5 days steady state- 12 ours after last dose- repeat CBC + LFTS

23
Q

Target levels for Carbamazepine?

A

4-12 mcg/ml

24
Q

Carbamazepine side effects?

A

RASH

- cause, vomiting, diarrhoea, sedation, ataxia

25
Q

more serious side effects of Carbamazepine

A

AV conduction delays

  • Aplastic anemia and agranulocytosis
  • water retention due to vasopressin- like effect - hyponatremia
  • drug to drug interactions
26
Q

Lamotrigine can be used for?

A

neuropathic/chronic pain

  • bipolar depression
  • better in women of child bearing ages
27
Q

What do you need to do before starting on Lamotrigine ?

A

LFT’S

28
Q

initiation and titration of Lamotrigine?

A

25mg daily x 2 weeks

  • 50mg x 2 weeks
    = then increase to 100mg
29
Q

Lamotrigine - if patient stops their medication for 5 or more days, what do you do?

A

start at 25mg again

30
Q

Lamotrigine side effects -most severe?

A

toxic epidermal necrolysis and Stevens Johnson’s syndrome

31
Q

what can be seen in rare cases of using lamorigine?

A

blood dyscrasias

32
Q

List some drugs that can increase Lamorigine levels?

A

VPA (doubles concentration)

- sertraline

33
Q

First presentation of manic episode what medication would you start?

  • what do you do at start of treatment?
A

lithium

- serum creatinine and TSH

34
Q

Average starting dose of lithium is?

A

800mg

  • Can get G upset so encourage adequate fluid intake
35
Q

Valproic acid is also known as?

A

Depakote

36
Q

Rapid cycler with ETOH abuse, is seen secondary to a manic episode, what medication would you start?

A

Depakote

  • 250mg twice daily and titrate to 500mg
37
Q

what is common to see in patients with anticonvulsant treatment?

A

increase ion LFTS

- as long as they are not tripling in value - just monitor

38
Q

Acute manic episode and patient is detained under MHA, lashing out, aggressive - what do you give?

A

IM
- combo of antipsychotics
Olanzapine or Aripipraxole and benzodiazepine (Lorazepam)

Year 3 - Psychiatry (7 decks)

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