Mood Stabilizers

Question 1

lithium

Answer 1

eskalith

Question 2

MOA of lithium

Answer 2

unknown

Question 3

indication of lithium

Answer 3

acute mania and maintenance of bipolar disorder (considered 1st line)

Question 4

side effects of lithium

Answer 4

GI distress, weight gain, fine tremor, cognitive impairment

Question 5

is lithium toxic or fatal in overdose?

Answer 5

it can be - n/v/d, corse tremor, ataxia, sludder speech, confusion, arrhythmia

Question 6

long term side effects of lithium

Answer 6

kidney: concentrating defects, nephrogenic diabetes insipidus
hypothyroidism, goiter
cardiac arrhythmia due to sinus node dysfunction

Question 7

are baseline labs needed before placing a patient on lithium?

Answer 7

CBC, BMP, EKG, TSH/T4, bHCG

Question 8

do lithium levels need to be monitored?

Answer 8

YES, every 2-6 months along with TSH and kidney function

Question 9

pregnancy category

Answer 9

D -> cardiac anomalies

Question 10

valproate

Answer 10

depakene, depakote

Question 11

MOA valproate

Answer 11

reason for therapeutic effect not understood

Question 12

indication for valproate

Answer 12

actue mania and maintenance for BPD, schizoaffective d/o, schizophrenia, restrictive depressive d/o, impulse control d/o, borderline PD, behavioral disturbances associated with developmental disability

Question 13

black box warnings for valproate

Answer 13

1. hepatotoxicity - usually within the first 6 months, mostly

Question 14

common side effects for valproate

Answer 14

GI upset, weight gain, sedation, tremor, hair loss

Question 15

can valproate be combined with lithium?

Answer 15

YES

Question 16

can valproate be combined with lamictal?

Answer 16

NO - SJS

Question 17

baseline screening for valproate?

Answer 17

YES LFTs, CBC, platelet, bHCG

Question 18

monitoring for valproate?

Answer 18

alproic acid levels, LFTs after 1 month then every 6-24 months

Question 19

lamotrigine

Answer 19

lamictil

Question 20

MOA of lamictil

Answer 20

blocks Na channels in the brain related to neuron firing which diminishes the buildup of glutamate in the CSF, modest inhibition of serotonin reuptake

Question 21

indications for lamictil

Answer 21

maintenance of BPD (NOT FDA approved for acute)

Question 22

what happens if you increase the dose of lamictil too quickly?

Answer 22

SJS

Question 23

side effects of lamictil

Answer 23

mild - dizzy, HA, blurred vision, nausea, back/joint pain, cognitive impairment often self reported

Question 24

labs for lamictil?

Answer 24

NOPE, no baseline or monitoring

Question 25

How is lithium secreted?

Answer 25

Kidney

Question 26

Onset of action of lithium

Answer 26

5-7 days

Question 27

Major drawback of lithium

Answer 27

High incidence of side effects and a very narrow therapeutic index

Question 28

Carbamazepine

Answer 28

Tegretol

Question 29

What type of drug is Tegretol?

Answer 29

Anticonvulsant

Question 30

Use of Tegretol

Answer 30

Mixed episodes and rapid cycling bipolar disorder | Also used in management of trigrminal neuralgia

Question 31

MOA of Tegretol

Answer 31

Blocks Na channels and inhibits action potentials

Question 32

Onset of Tegretol

Answer 32

5-7 days

Question 33

Side effects of Tegretol

Answer 33

Rash, drowsiness, ataxia, slurred speech, leukopenia, hyponatremia, aplastic anemia, agranulocytosis and elevation of liver enzymes

Question 34

Can Tegretol be given in pregnancy?

Answer 34

No! It's teratogenic

Question 35

What labs should be monitored if a patient is on Tegretol?

Answer 35

CBC and LFTs