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mood stabilizers Flashcards

(73 cards)

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1
Q

what are the 5 main mood stabilizers

A

carbamazepine
lamotrigine
lithium
oxcarbazepine
valproate

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2
Q

brand name of carbamazepine

A

tegretol

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3
Q

brand name of lamotrigine

A

lamictal

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4
Q

brand name of lithium

A

eskalith

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5
Q

brand name of oxcarbazepine

A

trileptal

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6
Q

brand name of valproate

A

depakote

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7
Q

carbamazepine upward titration

A

start 200mg BID w/ food
increase by 200mg qd divided doses at weekly intervals

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8
Q

dosage range for carbamazepine

A

400-1200mg for bipolar

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9
Q

FDA approved uses for carbamazepine

A

acute/mixed mania

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10
Q

off label uses for carbamazepine

A

bipolar depression and maintenance

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11
Q

what two meds are particularly useful for rapid cycling

A

carbamazepine and lamotrigine

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12
Q

labs prior to starting carbamazepine

A

CBC
CMP
TSH
LFT

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13
Q

labs to monitor with carbamazepine

A

CBC
LFT
renal panel
TSH

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14
Q

pregnancy risk of carbamazepine

A

avoid
give all child bearing age women folate

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15
Q

sedation considerations with carbamazepine

A

very sedating
ER can decrease sedation

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16
Q

contraindications for carbamazepine

A

bone marrow suppression

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17
Q

what is unique about carbamazepine

A

it is a subtrate and an inducer of CYP450 3A4 so dosage must be increased after long term use

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18
Q

which meds are decreased by carbamazepine

A

birth control
caffeine
olanzapine
clozapine
duloxetine
mirtazapine
luvox

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19
Q

severe side effects of carbamazepine

A

stevens johnson syndrome
aplastic anemia
agranulocytosis

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20
Q

how long should you try lamotrigine before abandoning

A

10-12 weeks

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21
Q

upwards titration of lamotrigine

A

25mg x2wks
50mg x2 wks
100mg x1 wk
200mg on wk 6

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22
Q

titration of lamotrigine when given with valproate

A

25mg qod x2 wks
25mg qd x2 wks
50mg x1 wk
100mg wk6

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23
Q

interaction between lamotrigine and valproate

A

valproate doubles the concentration of lamotrigine

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24
Q

FDA approved uses for lamotrigine

A

Bipolar 1

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25
off label uses for lamotrigine
MDD adjunct
26
effect of lamotrigine on UDS
can cause false positive for PCP
27
pregnancy risk of lamotrigine
avoid
28
dc taper for lamotrigine
taper over at leat 2 weeks unless rash develops then taper over 2 days
29
severe side effects of lamotrigine
stevens johnson syndrome blood dyscrasias aseptic meningitis
30
lamotrigine and oral contraceptives
birth control decreases effectivenss of lamotrigine
31
when should you be cautious with lamotrigine
renal, hepatic, and cardiac impairment
32
initial dose for lithium
300mg BID or TID then titrate based on serum levels
33
therapeutic lithium levels for mania
1-1.5
34
therapeutic lithium levels for depression
0.6-1
35
therapeutic lithium levels for bipolar
0.7-1
36
FDA approved uses for lithium
acute/mixed bipolar mania and bipolar maintenance
37
off label uses for lithium
bipolar depression adjunct for treatment resistant depression
38
serum lithium level in the elderly
<0.6 is usually still effective
39
labs to monitor with lithium
CBC w/ diff BMP TSH calcium fasting glucose
40
what should you monitor if a patient is over 50 and taking lithium
ECG
41
how often should you draw lithium levels
every 1-2 weeks until therapeutic q2-3 months x6 months q6-12 months thereafter
42
what is important about the blood sample for lithium levels
must be trough
43
pregnancy risk with lithium
avoid
44
what if a patient on lithium is going to have ECT
hold lithium x2 day d/t increased risk of delirium
45
signs of lithium toxicity
tremor slurred speech poor coordination vomiting diarrhea excessive sedation
46
which medications can increase lithium toxicity
carbamazepine methyldopa phenytoin metronidazole NSAIDs
47
what can help with a lithium tremor
low dose propranolol
48
dc taper for lithium
taper slowly over 3 months
49
lithium and SSRIs
can exacerbate tremor and increase risk of serotonin syndrome
50
contraindications for lithium
GFR <50 severe cardiac impairment
51
intial dose for oxcarbazepine
600mg in divided doses
52
upwards taper of oxcarbazepine
increase by 300mg daily q3 days to a max of 2400mg
53
dosage range for oxcarbazepine
1200-2400mg qd
54
Only FDA approved use for oxcarbazepine
partial seizures
55
off label use for oxcarbazepine
bipolar
56
geriatric considerations with oxcarbazepine
lower doses d/t reduced creatinine clearance
57
pregnancy risk with oxcarbazepine
avoid
58
dose of oxcarbazepine with renal disease
decrease initial dose by 1/2
59
how to dc oxcarbazepine
taper slowly
60
what is different about oxcarbazepine's side effects compared to other mood stabilizers
less sedation and weight gain than other mood stabilizers may cause life threatening hyponatremia
61
oxcarbazepine and oral contraceptives
oxcarbazepine decreases effectiveness of birth control
62
initial dosage of valproate if mania is NOT acute
500mg qd
63
initial dose of valproate for acute mania
15mg/kg in 2 divided doses
64
FDA approved uses for valproate
acute/mixed mania
65
off label uses for valproate
seizures migraine prophylaxis bipolar depression
66
geriatric considerations for valproate
reduce starting dose and titrate slowly monitor fluid/nutritional intake
67
initial labs for valproate
CBC coagulation tests LFTs pregnancy test BMI
68
labs to monitor with valproate
LFTs and platelets for first few months then q6-12 months
69
pregnancy risk for valproate
avoid
70
when should you change from valproate
if weight gain exceeds 5% of starting weight
71
dc valproate
must taper slowly
72
contraindications for valproate
pancreatitis liver disease urea cycle DO
73
valproate and birth control
birth control decreases effectiveness of valproate

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