Mood Stabilizers Jeopardy Flashcards
(44 cards)
Blood levels of lithium should be drawn about this many hours after the last dose:
12 hours (trough)
For maintenance treatment of Bipolar disorder, lithium levels should generally be above this:
0.6-0.8 mEq/L
Before starting a young male patient on lithium, labs that should routinely be done are these:
- TSH
- BUN/Creatinine
In lithium maintenance treatment, ideally these labs are done 1-2 times per year.
- Lithium level
- TSH
- BUN/Creatinine
This lithium side effect can be worsened by caffeine or improved with propranolol
treatment.
Tremor (resting or postural)
Unlike any antidepressant or mood stabilizer, Lithium treatment decreases patient’s mortality risk from this.
Suicide
Lithium toxicity with a lithium level greater than __ mEq/L is treated with dialysis.
4.0 mEq/L
To confirm therapeutic levels after starting lithium or increasing the dose, a lithium levelshould be done after this number of days.
5 days
T1/2 ~ 24hrs
For patients taking lithium, renal impairment, sodium depletion, or dehydration all increase the risk of this.
Lithium toxicity
Divalproex sodium (Depakote) exposure during the first trimester of pregnancy increases the risk this serious congenital anomaly.
Neural tube defect (spina bifida)
Before starting a male patient on divalproex sodium (Depakote), these two lab tests should be done:
- LFTs
- Platelets
If divalproex sodium (Depakote) is added to the medication regimen of a patient who is taking lamotrigine (Lamictal), this should be done:
Decrease lamotrigine dose by half
Valproic acid is an inhibitor of CYP2C9
Propranolol 2-3x’s per day may be used to treat this common side effect of divalproex sodium (Depakote).
Tremor
The age range of patients most at risk for divalproex’s (Depakote’s) side effect of serious, possibly fatal, hepatoxicity is this:
Under 2 years old
Patients on the generic form of valproic acid (Depakene) are at greater risk of developing this side effect than those on the enteric coated divalproex (Depakote).
GI side effects (N/V/D, GI discomfort)
Ironically, divalproex (Depakote) is indicated as prophylaxis for this condition, which is also one of divalproex (Depakote)’s common side effects.
Headache (indicated for migraine ppx)
For divalproex (Depakote), while the trough level of the immediate release (IR) should be drawn 12 hrs after the last dose, the trough level of extended release (ER) should be drawn at this time .
18 hour after the last dose
- If IR-last dose 10pm, blood draw 10am
- If ER-last dose 10pm, blood draw 4 pm
For a patient taking divalproex sodium (Depakote), taking aspirin increases the risk of this:
Thrombocytopenia
Over the first few weeks of taking carbamazepine (Tegretol), its T1/2 will decease to less than 50% of its initial T1/2 due to this:
Auto-induction
Exposure of the fetus to carbamazepine (Tegretol) during the 1st trimester of pregnancy leads to an unacceptable risk of this:
Neural tube defects
Carbamazepine (Tegretol) has a black box warning for these two rare (~1/100,000 = 0.001%) but serious side effects on the hematopoietic system:
- Agranulocytosis
- Aplastic anemia
This electrolyte may be abnormally low in patients who are taking carbamazepine (Tegretol).
Sodium
Carbamazepine (Tegretol) is both a substrate and an inducer of this cytochrome p450 enzyme system, which makes up ~55% of the cytochrome p450 enzymes.
CYP 3A4
Carbamazepine (Tegretol)’s drug-drug interaction with hormonal birth control increases the risk of this:
Pregnancy
