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Benzo and Mood Stabilizers Flashcards

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1
Q

What are the properties of benzos?

A

Anxiolytic

Hypnotic

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2
Q

What do anxiolytic agents do?

A

Reduces anxiety and produces a calming effect with little effect on motor and mental functions
Decreases activity, moderates excitement, and calms

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3
Q

What do hypnotic agents do?

A

Produces drowsiness and facilitates the onset and maintenance of a state of sleep

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4
Q

How is GABA modulated?

A

Allosterically modulated by a number of nearby receptors

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5
Q

What is the MOA for benzos?

A

Increase the frequency of Cl channel opening through allosteric modulation, allowing influx of Cl ions

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6
Q

How do benzos enhance GABA’s effect?

A

Allosterically modulates the GABA A receptor binding site, which in turn modulates the chloride channel

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7
Q

What are the most common SEs of typical benzo use?

A 
Sedation
Drowsiness
Memory difficulties
Fatigue
Muscle relaxation/weakness
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8
Q

What are the side effects of an overdose of benzos?

A 
Over sedation
Confusion
Dysarthria
Diplopia
Ataxia
Lethargy
Dizziness
Difficulty breathing
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9
Q

What are the contraindications/wanrings to benzos?

A 
Hypersensitivity
Acute narrow angle glaucoma
Sleep apnea
Severe respiratory insufficiency
Use of concomitant CNS depressants
Patients with h/o drug dependence
Abrupt withdrawal
Falls and mental alertness
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10
Q

What are benzo withdrawal symptoms?

A 
Anxiety
Agitation
Insomnia
Restlessness
Muscle tension
Irritability
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11
Q

What is considered long term use of benzoes?

A

1+ years

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12
Q

If a patient is using benzos for at least 2-6 months, what is the tapering schedule for discontinuation?

A

Slow taper by decreasing dose 10-25% every 4 weeks

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13
Q

What part of benzo withdrawal is paramount?

A

Patient education and careful monitoring

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14
Q

What is the MOA of anxiolytics?

A

5-HT1a partial agonist

5-HT2 agonist

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15
Q

What is an anxiolytic?

A

Buspirone

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16
Q

What is the onset of buspar?

A

Delayed (2+ weeks)

Don’t use PRN

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17
Q

What is Buspar approved for?

A

Approved for GAD

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18
Q

What is Buspar off label for?

A

Depression augmentation

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19
Q

Which drugs are key mood stabilizers?

A 
Lithium
Valproate
Carbamazepine
Oxcarbazepine
Lamictal
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20
Q

Which drugs are other agents that work as mood stabilizers?

A

Pregabalin
Gabapentin
Keppra
Topiramate

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21
Q

Which mood stabilizer were not shown to have an increased risk of suicidality?

A

Lithium

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22
Q

Which mood stabilizers are NTIs?

A

Lithium

Carbamazepine

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23
Q

What is lithium’s mechanistic consideration?

A

Alter cation transport
Neurotransmitter reuptake
Effects on second messenger systems

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24
Q

How is lithium adjusted?

A

CrCl < 50 (but must be stable)

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25
When are lithium troughs drawn?
8-12 hours post dose
26
What is the therapeutic range for lithium in acute mania?
0.8-1.2
27
What is the therapeutic range for lithium for prophylaxis?
0.6-1.0
28
What baseline labs must be taken before lithium treatment?
BUN, SCr, Thyroid function tests, ECG if patient > 40 or hx, CBC
29
What are the most common SE of Lithium?
``` Thirst Increased urination Tremor Wt gain Acne Hypothyroid WBC elevation ```
30
What are neurologic toxicity symptoms of lithium?
Coarse tremor Ataxia Confusion Visual changes
31
What drugs increase Li levels?
NSAIDS ACE/ARB NonDHP CCBs Thiazide
32
What drugs possibly decrease Li levels?
Loops Caffeine Theophylline
33
What drugs have an MOA of voltage-sensitive sodium channel (VSSCa) antagonism?
VPA CBZ Lamictal
34
When do we draw valproate troughs?
1 hour prior to next dose
35
What drug decreases VPA levels?
CBZ
36
What are the SE of VPA?
``` Anorexia Decreased plts Liver impairment Tremor Wt gain Hair loss ```
37
What enzymes does CBZ induce?
``` 3A4 1A2 2C9 2C19 2C8 Pgp ```
38
Which drug autoinduces its own metabolism?
CBZ
39
What genetic testing is necessary for CBZ?
HLA-B*1502 for SJS and TENs
40
What are the SEs of CBZ and OxCBZ?
``` GI upset Aplastic anemia LFT elevation Reduced efficacy of contraceptives Hyponatremia ```
41
How does OxCBZ compare to CBZ?
May be less sedating, less bone marrow toxicity, less 3A4 interactions, no autoinduction
42
What drug reduces lamotrigine levels?
Estrogen contraceptives
43
How do we titrate lamotrigine in bipolar disorder?
Slowly over weeks to help prevent rash
44
What is the titration schedule for lamictal in BD?
25mg QD x 2 weeks 50mg QD x 2 weeks 100 mg QD x 1 week 200mg QD
45
What do we do to the lamictal dose if that patient is taking VPA?
1/2 the dose
46
What do we do to the lamictal dose if the patient is taking CBZ
2x the dose
47
What are the SEs of lamictal?
Rash (SJS/TENs)
48
How much is VPA bound to protein?
80-95%
49
What is the use of topamax?
Bipolar adjunct (not to be used alone)
50
What are the SEs of topamax?
Dizziness, ataxia, somnolence, psychomotor slowing, memory difficulties, fatigue, decreased concentration, confusion
51
What is the MOA of pregabalin and gabapentin?
VSSCa Alpha-2-delta ligands
52
What are gabapentin and pregabalin used for?
Anxiety
53
What are the SE of pregabalin?
Dizziness | Cognitive impairment
54
What adjustments are needed for gabapentin?
Renal
55
What is the SE of gabapentin?
Dizziness
56
How is Keppra dose adjusted?
Renally
57
What are the SEs of keppra?
Behavioral sx Somnolence HA Hostility
58
How should Li be monitored?
``` CBC ECG Thyroid SCr, BUN TDM Wt Serum Ca Urine specific gravity UA UO Diet ```
59
What should be monitored with VPA?
``` CBC LFT SCr, BUN TDM Wt Na K Ammonia PT Bone marrow suppression ```
60
What should be monitored with LMTG?
``` CBC LFT SCr, BUN TDM Wt Rash ```
61
What should be monitored with CBZ/OxCBZ?
``` CBC (CBZ only) ECG LFT Thyroid SCr, BUN TDM HLA-B*1502 ```

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