Mood Stabilisers Flashcards
(18 cards)
when are mood stabilisers used
bipolar disorder, cyclothymia (depression+hypomania), schizophrenia
what are the main groups of mood stabilisers
Lithium
Anticonvulsants
Antipsychotics (see other flashcards)
Anixiolytics (see other flashcards)
what are some benefits of lithium
has decreased suicide rates compared to other drugs
can be used as long term prophylaxis for depression with mania (works better if the mania came before the depression)
what should be done before lithium is used
check baseline U&Es
check TSH levels
pregnancy test
how is the use of lithium monitored
should reach a steady state after 5 days
- check levels 12 hours after last dose
- check levels every three months
- check TSH and creatinine every 6 months
goal is a blood level of 0.6-1.2
what are the side effects of lithium
GI distress thyroid problems leukocytosis polyuria/polydipsia hair loss/acne cognitive slowing intention tremor
what are the levels of lithium toxicity and their side effects
mild - 1.5-2.0
- N/V, diarrhoea, ataxia, dizziness, slurred speech, nystagmus
moderte - 2.0-2.5
- N/V, anorexia, blurred vision, clonic limb movemebts, convulsions, delirium, syncope
severe - >2.5
- generalised convulsions, oligouria, renal failure
what are the three main anticonvulsants
Valproic acid
Carbamazepine
(Lamotrigine)
what are the pros of using valproic acid
good for mania prophylaxis (less for depression)
better tolerated than lithium
good for combined substance issues/anxiety
what must be checked before valproic acid is used
check baseline LFTs
pregnancy test
FBC
start folic acid supplement in women
how is the use of valproic acid monitored
steady state after 4-5 days
- check levels 12 hours after last dose as well as FBC and LFTS
- levels should be 50-125
what are the side effects of valproic acid
thrombocytopenia, platelet dysfunction N/V weight gain sedation, tremor increased risk of neural tube defect increased hair loss
what are the pros of using carbamazepine
its a first line agent for acute mania
good for mani prophylaxis
good for rapid cycler or comorbid conditions
what must be checked before carbamazepine is used
baseline LFTs, FBC, ECG
how is the use of carbamazepine monitored
steady state after 5 days
- 12 hours after last dose to check FBC, LFTs
- levels should be 4-12 mcg/ml
what are the side effects of carbamazepine
rash N/V diarrhoea sedation, dizziness, ataxia, confusion AV conduction delay aplastic anaemia water retention drug-drug reactions
why is it important to know about drug to drug reactions with carbamazepine
it increases its own metabolism and that of many other drugs
what are the side effects of lamotrigine
N/V
seation, dizziness, ataxia, confusion
TEN, steven johnsons syndrome**
**discontinue if any rash occurs
