Mood Stabilisers

Question 0

What is bipolar 1?

What is bipolar 2?

What should you check if you suspect bipolar?

Answer 0

abnormally different

Hypomanic, grand, irritable, elevated mood.

Thyroid function. Substance misuse.

Question 1

What are the first line medications used for bipolar?

Answer 1

Lithium, Olanzapine and Valproate

Question 2

What should you prescribe for rapid cycling?

What is the other name for Valproic Acid?

What is the other name for Sodium Valproate?

Answer 2

Valproate

Depakote

Epilim

Question 3

What is the dosage of valproate?

Answer 3

750mg in divided doses to 1-2g. (Both epilim and depakote).

Question 4

What are the side-effects of Valproate?

Which has the lowest Valproate levels, Depakote or Epilim?

Answer 4

Gastro-intestinal and hair loss.

Depakote.

Question 5

What are the symptoms of bipolar depression?

When should you avoid antidepressants?

Answer 5

Irritability, guilt, feeling restless, weight gain, sleeping a lot, moving slowly.

In rapid cycling.

Question 6

What dose of SSRI should you use?

What would you consider if SSRI not working?

What is the risk with TCAs

Answer 6

Minimum therapeutic dose.

Mirtazepine or Venlafaxine.

More risk of switching.

Question 7

When would you use Lamotrigine?

What are the dosages?

Answer 7

Bipolar Depression.

25mg for 14 days initially up to 200mg maintenance.

Question 8

What are the dosages of Olanzapine?

What are the side effects?

Answer 8

5mg - 20mg

Weight gain.

Question 9

If not using Olanzapine, what other antipsychotics would you use?

Which are black triangle or less suitable?

Answer 9

Quetiapine, Risperidone.

Aripiprazole, Asenapine.

Question 10

What are the side-effects of Lithium?
what are the signs of overdose?

What is Lithium protective in?

Answer 10

Gastro-intestinal, Fine Tremor.
tremor, ataxia, renal impairment, convulsions.

Suicidality.

Question 11

What are the normal blood levels of lithium?

When should bloods be taken?

What can high levels lead to and how many mmol/litre can be fatal.

Answer 11

0.6 - 0.8mmol/litre

12 hours post dose.

Hypothyroidism. 1.5mmol/litre.

Question 12

When would you prescribe Carbamazepine?

What is the dosage of Carbamazepine?

What symptoms indicate that you should stop Carbamazepine?

Answer 12

If unresponsive to Lithium.

600mg - 1.6g.

Rash, headache, fever - auto-immune response.

Question 13

Should you increase Carbamazepine if relapse?

What is Carbamazepine an inducer of?

Answer 13

No. Add an antipsychotic.

other medications.

Question 14

What system in the body may lithium affect?

What drugs should you avoid if taking lithium?

How would you know if there are renal problems.

Answer 14

Renal.

Diuretics.

Createnine 1.5 +

Question 15

What is the dosage of Lithium?

What other drugs should you avoid with lithium?

Answer 15

400mg - 1.2g

NSAIDs, ace-inhibitors.

Question 16

What anxiolytic would you use initially in behavioural disturbance or agitation?

Answer 16

Lorazepam.

Question 17

Which drug should not normally be prescribed for women of childbearing potential?

Answer 17

Valproate/Valproic acid/semi-sodium valproate.

Question 18

Lithium is used for treatment of mania, hypomania and depression in bipolar disorder and in the treatment of recurrent unipolar depression.
What disorder is lithium associated with.

What medications can add risk to the use of lithium?

Answer 18

Thyroid and mild cognitive impairment.

NSAIDS, ACE inhibitors or diuretics.

Question 19

What else can lithium be prescribed for?

Answer 19

self-harming and aggressive behaviour.