Mood Stabilising Drugs

Question 1

what is lithium used in

Answer 1

bipolar disorder to prevent replapses

Question 2

what needs to be monitored on a patient on lithium

Answer 2

U+Es every month
Thyroid function every 6-12 months
creatine clearance every 12 months

Question 3

mneumonic for remembering lithium side effects

Answer 3

LITHIVM

Leukocytosis 
diabetes insipidus 
Tremor
Hypothyroidism 
Increased weight 
Vomiting
Miscellaneous (dry mouth/polyuria)

Question 4

toxic side effects of lithium

Answer 4

confusion 
drowsiness
convulsions 
slurred speech
ataxia 
vomiting + diarrhoea

Question 5

ECG changes in lithium toxicity

Answer 5

T wave flattening or inversion

Question 6

what drugs should be avoided with lithium

Answer 6

NSAIDs
ACEI
Diuretics

Question 7

contraindications of lithium

Answer 7

pregnancy 
breast feeding 
impaired renal function 
thyroid disease
cardiac conditions 
neurological conditions (such as Parkinson's)

Question 8

examples of anti-convulsants

Answer 8

sodium valproate
lamotrigine
carbamazepine

Question 9

what is sodium valproate often used to treat

Answer 9

mania

Question 10

mechanism of action of sodium valproate

Answer 10

increases GABA

Question 11

side effect of sodium valproate use in pregnancy

Answer 11

neural tube defects

Question 12

side effects of sodium valproate

Answer 12

VALPROATE

Vomiting 
Alopecia / Ataxia 
Liver toxicity 
Pancreatitis / Pancytopenia 
Retain fat (increase weight)
Odema
Appetite increase
Tremor 
Encephalopathy

Question 13

what is lamotrigine used for

Answer 13

bipolar depression

Question 14

mechanism of action of lamotrigine

Answer 14

blocks sodium channels- decreases glutamate release

Question 15

side effects of lamotrigine

Answer 15

GI upset, insomnia, dizziness, diplopia, ataxia, steven Jonson syndrome

Question 16

what do you need to be careful of with carbamazepine

Answer 16

AGRANULOCYTOSIS

Question 17

side effects of carbamazepine

Answer 17

N+V
ataxia, dizziness, slurred speech, diplopia
raised liver enzymes – hepatic toxicity.
P450 inhibitor
hyponatremia – fluid retention. SIADH
AGRANULOCYTOSIS

Question 18

Mode of action of anti-psychotics

Answer 18

block dopamine receptors

Question 19

what are the 1st generation anti-psychotics

Answer 19

typical anti-psychotics

- haloperidol, chlorpromazine

Question 20

what are 2nd generation anti-psychotics

Answer 20

atypical anti-psychotics

- olanzapine, risperidone, clozapine

Question 21

contraindications to anti-psychotics

Answer 21

epilepsy 
cardiac disease
parkinsons 
phaechromocytoma
reduced conscious level

Question 22

which type of anti-psychotics has higher risk of extra-pyramidal side effects

Answer 22

typical antipsychotics

e.g. haloperidol, chlorpromazine

Question 23

what causes extra pyramidal side effects

Answer 23

excessive acetylcholine and relative dopamine deficiency

Question 24

what are some extra pyramidal side effects

Answer 24

acute dystonic reaction
Parkinsonism
akathisia
tardive dyskinesia

Question 25

what is an acute dystonic reaction

Answer 25

muscle spasms e.g torticollis, oculogyric crisis

Question 26

how do you treat acute dystonic reaction

Answer 26

acetylcholine antagonists

Question 27

what causes Parkinsonism

Answer 27

blockage of D2 receptors in the substantia nigra

Question 28

what is akathisia

Answer 28

internal restlessness

Question 29

what drug is most associated with akathisia

Answer 29

haloperidol

Question 30

what is tardive dyskinesia

Answer 30

repetitive involuntary purposeless movements e.g. sticking out tongue, lip smacking

Question 31

treatment of akathisia

Answer 31

propanolol or short term benzodiazepines

Question 32

treatment of extrapyramidal side effects

Answer 32

procyclidine

Question 33

what is neuroleptic syndrome

Answer 33

increased temperature, fluctuating consciousness, muscle rigidity, autonomic dysfunction creatine and phosphokinase will be raised

Question 34

when is clozapine given

Answer 34

treatment resistant schizophrenia

Question 35

what receptor does clozapine block

Answer 35

D4

Question 36

main risk of clozapine

Answer 36

AGRANULOCYTOSIS

Question 37

general side effects of clozapine

Answer 37

drooling, sedation, weight gain

Question 38

which atypical antipsychotic is given as first line

Answer 38

olanzapine

Question 39

main side effect of atypical anti psychotics

Answer 39

metabolic syndrome - obesity, hypertension, high cholesterol, diabetes

Question 40

odd side effect of chlorpromazine

Answer 40

blue grey discolouration in the sun

Question 41

general side effects of antipsychotics

Answer 41

``` prolonged QT interval arrhythmia skin rash hepatotoxic pancytopenia drowsiness ```

Question 42

which atypical antipsychotic does not cause drowsiness

Answer 42

ariprizole

Question 43

antipsychotics can increase risk of what in elderly patients

Answer 43

stroke

Question 44

treatment of tardive dyskinesia

Answer 44

tetrabenazine

Question 45

treatment of akathisia

Answer 45

propanol

Question 46

treatment of dystonia

Answer 46

procyclidine