Mood Stabilisers Flashcards
(23 cards)
What is the goal of acute treatment of bipolar?
- Reduce mood in mania
- Raise mood in depression
What is the goal of long term treatment of bipolar?
-To stabilise mood and prevent recurrence of depression/mania
What is the most common form of Lithium given to patients?
-usually given as lithium carbonate
What are the risks of prescribing lithium?
Narrow therapeutic index. 12h post-dose blood levels have to be monitored.
What are the common side effects of lithium?
- dry mouth
- polydypsia/polyuria
- hypothyroidism
- Renal function (long term)-DO NOT PRESCRIBE NSAID simultaneously
- weight gain
- Diabetes insipidus
- sedation (TAKE AT NIGHT)
What are the toxic effects of lithium?
GI upset (nausea, vomiting, diarrhea) CNS (ataxia, tremor, convulsions, coma)
What other drugs can stabilise mood?
Anticonvulsants Antipsychotics
- lamotrigine (bip. dep.) -Quetiapine
- carbamazepine -Aripiprazole
- valproic acid(bip. h/mania) -Olanzapine
- Lurasidone
- Haloperidol (old)
- chlorpromazine (old)
Side effects of these drugs?
- lamotrigine: Steven Johnson’s Syndrome (small risk)
- Valproic acid: teratogenicity (neural tube defect)
- carbamazepine: CVS effects, drowsiness, ataxia, induction of liver enzymes
What are the modes of action of antipsychotics?
Dopamine and serotonin antagonist
Side effects of antipsychotics?
- Sedation
- weight gain
- metabolic syndrome (olanzapine)
- extrapyramidal symptoms (aripiprazole)-akathisia
What are the uses of lithium carbonate?
- most effective treatment for bipolar
- used as an adjunct to antidepressants for treatment resistant depression
- It can be combined with most other psychotropics
What drugs may interact with lithium?
- NSAID
- ACEI
- angiotension II receptor antagonist
- Diuretics (especially thiazide)
What is the protocol for lithium monitoring?
prior to initiation: U&E, TFT, ECG
initiation: lithium level 12h after last dose. U&E every 5 days until lithium level stable within therapeutic range
Every 3 months: Lithium level and U &E
Every 6 months: TFT (hypothyroidism treated with levothyroxine instead of stopping lithium)
What is the mechanism of action of sodium valproate?
Block sodium channels and increases GABA levels. Effective in bipolar mania/hypomania
what are the side effects of sodium valproate?
- sedation
- tremor
- dizziness
- GI upset
- Suicidal ideation (Rare)
- pancreatitis/hepatotoxicity (Rare)
What must be checked prior to initiation of sodium valproate?
- platelet count
- liver function
What is lamotrigine?
Anti-convulsant. Can be used in treatment and prophylaxis of bipolar depression. Some evidence suggests anti-manic properties
What are the uses of atypical antipsychotics in bipolar?
- treatment and prophylaxis of both manic/hypomanic and depressed mood states in bipolar.
- combine with antidepressant for psychotic unipolar depression
- combine with antidepressant for unipolar depression wihout psychotic symptoms
Which atypical antipsychotics are available in IM depot?
- risperidone
- olanzapine
What are the uses of typical antipsychotics in bipolar?
Same as atypical antipsychotics
What is the mechanism of action of typical antipsychotics?
dopamine 2 receptor blockade (mainly
What are the side effects of typical antipsychotics?
- extrapyramidal side effects
- sedation
- dizziness
- QTc prolongation
- hyperprolactinemia
- neuroleptic malignant syndrome (fever, muscle rigidity, altered mental status, autonomic dysfunction(
Which class of antipsychotics are usually used in mood disorders?
atypical antipsychotics
