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31 Cards in this Set
- Front
- Back
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What is the first line drug for treating mania and mixed-mania?
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Valproic acid
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What are the 2 mechanisms by which Valproic acid works?
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-Increases GABA concentrations
-Blocks Na channels |
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What type of effect is mainly seen with valproic acid?
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Sedating
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What is a major side effect of valproic acid?
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Teratogenicity - spina bifida
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What is one of the psychiatric drugs that has no behavioral effects on normal individuals?
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Lithium carbonate
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What effect does Lithium carbonate have on manic patients?
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Blocks manic behavior - but it takes time to work.
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What is the mechanism of action of Lithium Carbonate?
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Blocks PIP2 availability for IP3/DAG by inhibiting the recycling of IP substrates (phosphatase of IP2->IP1)
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How is Lithium carbonate administered?
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Orally
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How does Lithium carbonate act in the body?
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-Not bound to plasma proteins
-Rapidly distributes to peak serum conc in 2-4 hrs |
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In what patients does Lithium Carbonate have a longer half life?
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Elderly
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How is Lithium carbonate excreted?
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In urine primarily, and with extensive tubular reabsorption
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What has major effects on the level of Lithium excretion?
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Plasma sodium levels!!
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What will increased Na levels in plasma result in? Why?
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Increased Lithium excretion bc less Na is excreted
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What will Decreased Na in plasma result in?
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Less Lithium excretion because more Na is excreted
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So what effect will thiazide diuretics or furosemide have?
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Increase Na excretion so increased plasma Lithium - toxicity!
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Why do such little alterations in plasma lithium levels easily cause toxicity?
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Bc Lithium carbonate has a very narrow therapeutic window
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So what are 3 drugs that will cause interactions with Lithium carbonate?
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-Thiazides
-ACE inhibitors -ARBs |
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What other condition can affect Na levels and Lithium levels?
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Pregnancy
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What are the 3 main early symptoms of lithium toxicity?
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-Fatigue/muscle weakness
-Tremor -GI symptoms |
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What can treat the tremor due to Li toxicity?
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Propanolol - B-blockers
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What GI symptoms does Li toxicity produce?
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Nausea/vomiting/diarrhea
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What are 3 later reactions to lithium?
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-Goiter
-Slurred speech -Ataxia |
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At what plasma level does Lithium carbonate cause serious toxicity?
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2 mEq/L
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What are 3 symptoms of serious toxicity due to Lithium carbonate?
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-Impaired consciousness
-Rigidity/hyperactive deep reflexes -Coma |
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In what patients should Li carbonate be used with extreme caution?
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Pregnant and breast-feeding
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What is the therapeutic range of Lithium carbonate?
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.6-1.2 mEq/L
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What are 5 therapeutic uses of Lithium Carbonate?
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CHAMM
-Cluster headaches -Hyperkinetic disease (Huntingt) -Aggressive/violent behavior -Manic episodes/recurrent bipolar episode prevention -Prevent unipolar depression recurrence |
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What antiepileptic has been used in nonresponders to lithium?
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Carbamazepine
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What drug can be used for quick control of manic symptoms?
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Clonazepam
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What is Symbax?
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Olanzapine and fluoxetine combined
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What is Symbax (olanzapine and fluoxetine) used for treating?
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Depressive episodes in bipolar disease
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