Mood Stabilizers Flashcards Preview

Term IV: Behavioral Science > Mood Stabilizers > Flashcards

Flashcards in Mood Stabilizers Deck (21):
1

Lithium

Uses various signal transduction sites beyond neurotransmitters - G proteins, gene expn, 2nd messengers

Treats:
- Manic episodes, prevents recurrence
- Depressive phase of bipolar disorder
- Sometimes used as augmentation agent for depressive illnesses

2

What organ exclusively excretes Lithium? What does it excrete it with?

Kidney, with Na+

3

What condition poses a risk of lithium toxicity?

Hyponatremia

4

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

5

Lithium: Wide or narrow therapeutic index?

Narrow

6

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

7

Side FX of Li that causes a tricuspid valve defect in 1st trimester of pregnancy?

Ebstein's anomaly

8

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

9

Avoid prescribing Li to patients with what medical conditions?

- Cardiac conduction problems
- Impaired renal function

10

Coarse tremor, vomiting, ataxia, dysarthria, confusion, seizures

Symptoms of Li toxicity

11

Are anticonvulsants effective as mood stabilizers?

Not all of them - depends on mechanism of action

12

Valproic Acid/Divalproex
(Depakote)

Anticonvulsant that inhibits voltage sensitive Na+ channels, increases action of GABA, regulates downstream signal cascades

Effective in acute phase of mania

13

Metabolism of Valproic acid/Divalproex (Depakote)

Hepatic - inhibits P450 enzymes

14

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

15

Lamotrigine (Lamictal)

Anticonvulsant, used off label for depressed phase, not appropriate for mania

Inhibits voltage-sensitive Na+ channels, inhibits glutamate release, blocks Ca2+ channels

16

Metabolism of Lamotrigine (Lamictal)

Combination with what drugs affect its levels?

Hepatic - levels increased by valproic acid and decreased by carbamazepine

17

Side FX of Lamotrigine (Lamictal)

Relatively few - some sedation

1/1000 risk of Stevens-Johnson sydrome and toxic epidermal necrolysis

18

Carbamazepine (Tegretol) and Oxcarbamazepine (Tripletal)

Which one is effective in treating mania?

Anticonvulsants

Blocks voltage sensitive Na+ channels, enhances GABA function

Carbamazepine for acute mania

19

Metabolism of Carbamazepine (Tegretol) and Oxcarbamazepine (Tripletal)

Which induces hepatic enzymes, increasing its own metabolism as well as metabolism of other drugs? (TEST QUESTION)

Hepatic

Carbamazepine/Tegretol

20

Side FX of Carbamazepine (Tegretol)

Sedation, rash progression to Stevens-Johnson, SIADH (hyponatremia), neural tube defects, decreases effectiveness of oral contraceptives

21

Side FX of Oxcarbamazepine (Tripletal)

Sedation, higher risk of SIADH