Flashcards in Mood Stabilizers Deck (21):
Uses various signal transduction sites beyond neurotransmitters - G proteins, gene expn, 2nd messengers
- Manic episodes, prevents recurrence
- Depressive phase of bipolar disorder
- Sometimes used as augmentation agent for depressive illnesses
What organ exclusively excretes Lithium? What does it excrete it with?
Kidney, with Na+
What condition poses a risk of lithium toxicity?
What should patients avoid when taking Lithium?
Becoming dehydrated (during exercise), Na+ depleting diuretics, low Na+ diets, NSAIDs b/c of their effect on renal prostaglandin synthesis and Na+ excretion
Lithium: Wide or narrow therapeutic index?
What must you check before starting a patient on Li?
Renal function - BUN and creatinine, Baseline thyroid function, Urine pregnancy test, EKG, baseline blood count
Side FX of Li that causes a tricuspid valve defect in 1st trimester of pregnancy?
Tremor, nausea and diarrhea, nephrogenic diabetes insipidus, hypothyroidism, weight gain, alopecia, interference of conduction in SA node, Ebstein's anomaly, leukocytosis
Side FX of lithium
Avoid prescribing Li to patients with what medical conditions?
- Cardiac conduction problems
- Impaired renal function
Coarse tremor, vomiting, ataxia, dysarthria, confusion, seizures
Symptoms of Li toxicity
Are anticonvulsants effective as mood stabilizers?
Not all of them - depends on mechanism of action
Anticonvulsant that inhibits voltage sensitive Na+ channels, increases action of GABA, regulates downstream signal cascades
Effective in acute phase of mania
Metabolism of Valproic acid/Divalproex (Depakote)
Hepatic - inhibits P450 enzymes
Side FX of Valproic Acid/Divalproex (Depakote)
What types of patients should you not use this drug with?
Sedation, weight gain, alopecia, tremor
Pts with clotting abnormalities- causes thrombocytopenia
Pts with liver disease - causes hepatotoxicity
Anticonvulsant, used off label for depressed phase, not appropriate for mania
Inhibits voltage-sensitive Na+ channels, inhibits glutamate release, blocks Ca2+ channels
Metabolism of Lamotrigine (Lamictal)
Combination with what drugs affect its levels?
Hepatic - levels increased by valproic acid and decreased by carbamazepine
Side FX of Lamotrigine (Lamictal)
Relatively few - some sedation
1/1000 risk of Stevens-Johnson sydrome and toxic epidermal necrolysis
Carbamazepine (Tegretol) and Oxcarbamazepine (Tripletal)
Which one is effective in treating mania?
Blocks voltage sensitive Na+ channels, enhances GABA function
Carbamazepine for acute mania
Metabolism of Carbamazepine (Tegretol) and Oxcarbamazepine (Tripletal)
Which induces hepatic enzymes, increasing its own metabolism as well as metabolism of other drugs? (TEST QUESTION)
Side FX of Carbamazepine (Tegretol)
Sedation, rash progression to Stevens-Johnson, SIADH (hyponatremia), neural tube defects, decreases effectiveness of oral contraceptives