Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
31 Cards in this Set
- Front
- Back
|
Lithium MOA
|
Unknown
1-decreased rec-med signal transduxn, dec adenylyl clyclase 2-dec inositol phosphatase-dec receptor activated PIP2 hydrolysis-dec IP3, DAG |
|
|
Li PK
|
ER available
Vd approaches total body H2O, slowly passes thru BBB @ ss, CSF concentration=~40% plasma Biphasic elimination renal |
|
|
Na depletion and Li
|
Increased Li reabsorption
|
|
|
Lithium Uses
|
Acute mania
Px of recurrent bipolar disorder Alt to heterocyclic antidepressants@sever recurrent depression Supplement to antidep @acute major depression EtOH, aggression, PMS Mood disorders |
|
|
Li AE d 1
|
Inc excretion of 17-OH corticosteroids, Na, K, H2O
|
|
|
Li AE d 2-5
|
K excretion normal
Na retained, pretibial edema Inc aldosterone, give spironolactone |
|
|
Li AE d 6-8
|
Edema
Na retention, usually abates |
|
|
Li AEs
|
Polydipsia, polyuria
Diabetes insipidus, give amiloride Monitor kidney fxn |
|
|
Amiloride effect on [Li]
|
Decreased
|
|
|
Thiazide effect on [Li]
|
Increased, toxicity
|
|
|
Lithium CNS AE
|
tremor
nausea mm hypertonicity transient choreoathetosis, ataxia, aphasia mental confusion weight gain |
|
|
Lithium Thyroid AE
|
Benign, diffuse, nontender thyroid enlargement, pt remain euthyroid
Rare-goiter=stop Li Rx |
|
|
Li Overdose
|
Convulsions, coma, confusion, coarse hand tremor, mm rigidity, fasciculations, ataxia
Li accumulation from dec Na (diuretics, change in renal fxn, pregnancy) |
|
|
Rx of Lithium overdose
|
Osmotic diuretics, IV bicarb
If kidney fxn ok then dialysis |
|
|
Random Lithium AE
|
benign, reversible depression of T wave @prolonged use
Inc PMNs reversible@chronic Rx Dermatitis Do not use nursing |
|
|
Li drug interactions
|
Anti-psychotics
Sedatives Antidepressants Diuretics NSAIDS ACE inhibitors Last three decrease Li CL |
|
|
Sodium Valproate
|
Anticonvulsant
|
|
|
Sodium Valproate PK
Divalproex Sodium |
May enhance GABA Tx block voltage dep Na channels, augment K+ channels, T-type Ca++ channels
Serum protein binding 80% P450, mitochondrial beta-oxidation mtabolism |
|
|
Divalproex Sodium
|
enteric coated preparation
[peak] @4-6 hours Delayed aborption @ small intestine Decreased Nausea, stomach cramps, tremor |
|
|
Sodium Valproate
Divalproex Sodium Uses |
2nd choice mood stabilizer after Lithium
Acute mania Anti-mania prophylaxis Generalized seizures Partial seizures Migraine prophylaxis |
|
|
Sodium valproate
Divalproex sodium AEs |
Dose related:
-N/V -dizziness, somnolence, tremor, inc accidents -alopecia -benign thrombocytopenia increased liver fxn test Idiosyncratic -pancreatic -fulminant hepatitis TERATOGEN Drug interaxn |
|
|
Carbamazepine
|
anticonvulsant
|
|
|
Carbamazepine MOA
|
'phenytoin-like
Blocks Na channels Inhibits high-frequency repetitive firing of neurons Acts presynaptically to dec synaptic Tx Binds adenosine Receptors |
|
|
Carbamazepine PK
|
Rates of absorption varies
Peak @ 4-6 hr Slow distributionHigh serum protein binding Induces microsomal enzymes Inc metabolism of primidone, phenytoin, ethosuximide, valproate, clonazepine Monitor LFTs & carddiac fxn |
|
|
Carbamazepine Uses
|
3rd choice mood stabilizer
Acute mania Anti-mania prophylaxis mixed-state bipolar pt impacts manic > depressive phase prophylactic efficacy may dec w/time Partial seizures DOC generalized tonic-clonic seizurres Trigeminal neuralgia |
|
|
Carbamazepine AEs
|
Sedation, nausea, weakness, atazia, diplopia, horizontal nystagmus
GI upset, unsteadiness, drowsy Hyponatremia Aplastic anemia, agranulocytosis Lekopenia, erythematous skin rash |
|
|
Carbamazepine Overdose/toxicity
|
Drowsiness, ataxia, coma, cardiac toxicity
Treat w/gastric lavage, charcoal |
|
|
Carbamazepine Drug interaxn
|
Reduce t1/2 ofother drugs P450
Displace others from serum binding sites Pharmacodynamic interaxn w/LI in brain |
|
|
Valproate+Carbamazepine
|
Dec valproate inc carbamazepine
|
|
|
Lamotrigine
|
Use dependent inactive Na channels
Blocks release presynaptic glut, asp MANIA+DEPRESSION |
|
|
Lamotrigine AEs
|
Rash
Toxic epidermal necrolysis Steven-Johnson syndrome |
