Behavioral Science (Block 6): Mood Stabilizers

Front 1

name the 3 major categories of mood stabilizers

Back 1

lithium, anticonvulsants, atypical antipsychotics

Front 2

name the 4 drugs under anticonvulsants

Back 2

Carbamazepine
Oxcarbazepine
Lamotrigine
Divalproex

"Don't be so COLD to me"

Front 3

mechanism of lithium. how is it excreted?

Back 3

Second messenger system
1. Inhibits inositol monophosphotase
2. Affects protein kinase C (PKC)

EXCRETED EXCLUSIVELY THROUGH KIDNEYS (WITH Na) so pts with hyponatremia pose risk of lithium toxicity

Front 4

side effects of LITHIUM/contraindications?

Back 4

o Tremor
o Nausea/diarrhea (can be controlled with changes in dosage)
o Ebstein’s anomaly (tricuspid valve defect) in first trimester of pregnancy
- Avoid in patients with cardiac conduction problems
- Avoid in patients with impaired renal function

o Contradindications
- hyponatremia poses risk of lithium toxicity (don't get dehydrated, don't take diuretics that deplete sodium, no low Na diets)
- NO NSAIDS!!!

Front 5

uses of lithium

Back 5

- manic episodes and the prevention of recurrence
- effective in treating depressive phase of bipolar disorder

Front 6

important lab tests when putting someone on lithium

Back 6

-renal fxn test
-urine pregnancy test (before starting medication) to avoid Ebstein's anomaly in first trimester

Front 7

symptoms of renal toxicity with lithium

Back 7

visible/Coarse tremor, Vomiting, Ataxia, Dysarthria (difficulty in articulating words), Confusion, Seizure (may require dialysis if severe)

CVA tenderness... DCS

Front 8

Uses and Mechanism of Valproic acid/Divalproex (Depakote)

Back 8

Uses: mood stabilizer of choice with rapid cycling disorder, anti-convulsant (not useful for dysthmic patients)

mechanism: inhibit voltage gated sodium channels, inc action of GABA, regulate downstream signal cascades

Front 9

name the mood stabilizer of choice inn pt with rapid cycling disorder

Back 9

valproic acid/Divalproex

Front 10

metabolism of valproic acid/divalproex (depakote). what are the side effects?

Back 10

hepatic metabolism/inhibits p450 enzymes

SEs: - sedation
- weight gain
- alopecia (hair loss)
- thrombocytopenia (do NOT use in pts with clotting abnormalities)
- hepatotoxicity (do NOT use in pts with liver dz)

Think of Dival, the guy who's getting old, BALD, and FAT, FALLING ASLEEP on the couch!!

Front 11

which 2 patients should you not use valproic acid/divalproex with?

Back 11

pts with clotting abnormalities
pts with liver dz

Front 12

lab tests for divalproex/valproic acid (depakote)

Back 12

before starting: liver fxn test, blood count, pregnancy test

after starting: valproate levels, blood counts, liver function, inquire about possibility of pregnancy

Front 13

mechanism and uses of lamotrigine (lamictal)

Back 13

mechanism: inhibit voltage gated Na channels, inhibits glutamate release, possibly blocks calcium channels

uses: anti-convulsant, mood stabilizer

Front 14

contraindications for lamotrigine (lamictal)

Back 14

don't give with divalproex (depakote) bc of hepatic toxicity

Front 15

SEs of lamotrigine (lamictal)

Back 15

-relatively few side effects except SEDATION!!

-stevens-johnsons syndrome risk is increased with pt on this medication

Front 16

Carbamazepine (Tegretol) and Oxcarbamazepine (Tripletal) mechanism of action and metabolism

Back 16

blocks voltage sensitive sodium channels, enhances GABA fxn

Both are hepatically metabolized (carbamazepine induces own metabolism, oxcarb does not)

Front 17

which mood stabilizer increases the risk of stevens johnson syndrome?

Back 17

lamotrigine (lamictal)

Front 18

uses of carbamazepine (tegretol) and oxcarbamazepine (tripletal). what about SEs?

Back 18

-mania
- anticonvulsant

SEs for carbamazepine:
sedation
rash progression to stevens johnson
do NOT use in pts with liver disease or neutropenia
can cause neural tube defects, craniofacial defects, microcephaly in pregnancy
decreases effectiveness of oral contraceptives

SEs of oxcarbamazepine: fewer SEs, mainly sedation

Front 19

lab tests for carbamazepine

Back 19

before starting: liver fxn tests, blood counts, electrolytes, renal fxn, EKG, urine pregnancy test

to monitor: liver fxn tests, blood counts, electrolytes, renal fxn, carbamazepine levels, inquire about possibility of pregnancy

Front 20

lab tests for oxcarbamazepine

Back 20

NONE NEEDED!!!! =)