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Synopsis mood stabilizers Flashcards

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1
Q

how long to peak serum concentration for lithium

A

1-1.5 hours for standard
4-4.5 hours for ER

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2
Q

elimination half-life of lithium

A

18-24 hours

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3
Q

how if lithium metabolized and excreted

A

it is not metabolized. It is excreted through kidneys

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4
Q

therapeutic indications for lithium

A

-mania
-bipolar depression
-bipolar maintenance
-MDD
-schizoaffective disorder
0schizophrenia

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5
Q

Lithium onset when treating mania

A

typically slow. Exerts effect over 1-3 weeks

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6
Q

how do you treat the manic patient in the short term who has been initiated on lithium therapy

A

give benzodiazepine, DRA, SDA, or valproic acid as well for first few weeks

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7
Q

what should you connsider if a depressive episode occurs in a patient taking lithium

A

lithium-induced hypothyroidism
substance abuse
noncompliance

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8
Q

use of lithium in schizoaffective disorder and schizophrenia

A

-prominent mood sx more likely to respond than prominent psychotic symptoms
-useful for augmenting antipsychotics

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9
Q

Lithium in MDD

A

no more effective than other antidepressants for monotherapy. Usually used as adjunct in nonresponders

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10
Q

what is sodium’s effect on lithium levels

A

excessive intake lowers levels
hyponatremia causes toxicity
dehydration can cause intoxication

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11
Q

cardiac side effects of lithium

A

bradycardia and arrythmias

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12
Q

how can you decrease GI upset of lithium

A

take with food

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13
Q

does lithium cause weight gain? Why or why not?

A

yes d/t effects on carbohydrate metabolism
OR
d/t lithium-induced:
hypothyroidism
edema
thirst causing increased intake of soda

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14
Q

neuro side effects of lithium

A

tremor
cognitive effects

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15
Q

what can reduce lithium-induced tremor

A

propranolol 30-120mg daily (divided)
primidone 50-250mg daily

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16
Q

renal side effects of lithium

A

polyuria (if severe eval renal function)
polydipsia

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17
Q

thyroid side effects of lithium

A

goiter, hyperthyroidism, hypothyroidism

Monitor TSH q6 months

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18
Q

what places someone at a higher risk of cardiac side effects from lithium

A

low salt diet
diuretics/ACEIs
fluid/electrolyte imbalance
renal insufficiency

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19
Q

what are some dermatologic side effects of lithium

A

worsening of psoriasis
alopecia

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20
Q

early signs of lithium OD/toxicity

A

tremor
dysarthria
ataxia
GI sx
cardio changes
renal dysfunction

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21
Q

what are later signs of lithium OD/toxicity

A

loss of consciousness
muscular fasciculations
myoclonus
seizures
coma

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22
Q

how can lithium be removed from the body

A

kayexalate and miralax but not activated charcoal (GI tract)
hemodialysis

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23
Q

lithium and pregnancy

A

contraindicated during first trimester d/t risk of birth defects

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24
Q

most common birth defect associated with lithium

A

Ebstein anomaly

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25
what are some drugs that increase lithium concentrations
carbamazepine, lamotrigine, valproate, clonazepam, thiazide/K-sparing diuretics, ACEIs, NSAIDs
26
what are some drugs that decrease concentration of lithium
osmotic/loop diuretics, carbonic anhydrase inhibitors, xanthines
27
can you combine calcium channel blockers with Lithium? Why?
No because of risk of fatal neurotoxicity
28
how many days prior to ECT must lithium be discontinued
2 days to decrease risk of delirium
29
starting dose of lithium
300mg TID
30
labs prior to starting lithium
creatinine, electrolytes, thyroid function tests, CBC, ECG, pregnancy test
31
how often should lithium levels be checked
every 2-6 months weekly if dose adjustment. s/s toxicity, suspected noncompliance
32
how often should ECG be obtained with lithium
annually
33
effective lithium serum concentration for mania treatment
1-1.2 (associated w/ 1800mg daily)
34
effective serum concentration of lithium for maintenance
0.4-0.8 (associated w/ 900-1200mg daily)
35
therapeutic indications for valproate
-bipolar 1 (mania, depression, maintenance) -schizophrenia -schizoaffective disorder
35
what is the black box warning attached to valproate
pancreas and liver dysfunction
36
symptoms of severe hepatotoxicity with valproate
lethargy malaise anorexia N/V edema abdominal pain
37
what fetal abnormalities are associated with valproate
spina bifida (give folic acid) heart malformations
38
weight gain with valproate
common
39
what drugs can be safely combined with valproate
serotonin-dopamine antagonists and carbamazepine
40
can you give valproate with lamotrigine? why?
no because of increased risk of steven Johnson syndrome
41
baseline line labs before starting valproate
hepatic panel. CBC, platelet count, pregnancy test
42
how often should hepatic transaminase be monitored with valproate
one month after starting therapy then every 6-24 months
43
therapeutic indications for lamotrigine
bipolar maintenance
44
major side effect of lamotrigine
steven johnson syndrome (report rash)
45
what drugs decrease concentration of lamotrigine
carbamazepine phenytoin phenobarbital
46
what if 4+ days of lamotrigine are missed
must start at begining and titrate up again
47
dosage of lamotrigine for bipolat
100-200mg daily
48
how long is taper to dc lamotrigine
over 2 weeks, unless rash develops then dc over 1-2 days
49
half-life of carbamazepine
18-54 hours (average 26)
50
what happens to carbamazepine's half-life w/ chronic use (after 3-5 weeks)
it decreases to 12 hours
51
therapeutic indications for carbamazepine
acute mania prophylaxis acute depression
52
what are some common augmentation meds used with carbamazepine
lithium valproate thyroid hormones antipsychotics
53
how fast is response usually seen to carbamazepine when using for acute mania
within the first several days of treatment
54
what are some common side effects of carbamazepine
GI side effects, ataxia, drowsiness
55
what are some serious side effects of carbamazepine
blood dyscrasias hepatitis steven johnson syndrome renal side effects
56
what medication should always be coadministered with carbamazepine to women and why
folic acid because of the risk of neural tube defects in pregnancy
57
major drug interactions for carbamazepine
-decrease concentration of oral contraceptives -contraindicated w/ MAOIs -grapefruit juice inhibits metabolism
58
coadministration of carbamazepine and valproate
valproate displaces carbamazepine so may need to decrease dose and increase dose of valproate
59
carbamazepine lab interferences
cause decreased TSH increase total cholesterol
60
carbamazepine dosage for mania
1200mg daily
61
dosing carbamazepine with meal
absorption is faster when taken with high-fat meal
62
contraindications to carbamazepine
preexisting hematologic, hepatic, and cardiac diseases
63
dosage of carbamazepine with hepatic impairment
1/3 - 1/2 the dose
64
baseline labs for carbamazepine
CBC w/ platelets LFTs electrolytes EEG (if>40 or w/ preexisting condition)
65
how often do you monitor labs with carbamazepine
q2 weeks x2 months then quarterly
66
half life of oxcarbazepine
the parent compound is 2 hours but metabolite (monohydroxide) is 9 hours
67
most common side effects of oxcarbazepine
sedation and nausea
68
carbamazepine v/ oxcarbazepine side effects
oxcarbazepine more likely to cause hyponatremia but less likely to develop serious rash
69
metabolism of oxcarbazepine and drug interactions
-oxcarbazepine induces 3A4 and inhibits 2C19 -3A4 inducers increase clearance and decrease concentration (phenobarbital, alcohol)
70
excretion of gabapentin
excreted renally unchanged and can be removed by hemodialysis
71
therapeutic indications for gabapentin
seizures neuropathic pain can help w/ social anxiety/panic disorder
72
what labs will gabapentin create false positives of
amphetamines, barbiturates, benzodiazepines, marijuana
73
therapeutic indications for topirimate
migraine prevention obesity bulimia binge-eating alcohol dependence
74
most common side effects of topiramate
paresthesia weight loss somnolence anorexia dizziness memory problems
75
what drugs do topiramate increase the concentration of
phenytoin valproic acid
76
what drugs decreases concentration of topiramate
carbamazepine and phenytoin
77
what are some off-label uses for levetiracetam
acute mania adjunct w/ antidepressant anxiolytic
78
psych indications for phenytoin
bipolar mania
79
what is considered second-line treatment for acute mania
calcium channel blockers

Psychopharmacology (13 decks)

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