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;
25 Cards in this Set
- Front
- Back
|
what element does lithium behave similar to? large or small therapeutic window?
|
- sodium
- very small therapeutic window |
|
|
how long does lithium take to work? what does this mean for the short term?
|
- onset may take days to weeks
- acute symptoms therefore usually require additional therapy - benzos or antipsychotics |
|
|
what is lithiums mechanism of action?
|
- blocks a phosphatase to prevent inositol from being recycled
- suppresses CNS transmission through this mechanism of action - how this translates to mania & depression we have no idea |
|
|
what does lithium do to ADH?
|
- lithium blocks activity of ADH in the neprhon causing nephrogenic diabetes insipidus
- prevents kidney from responding to ADH in nephron |
|
|
what does lithium do to the thyroid?
|
- slows iodine production so can cause mild hypothyroidism
|
|
|
how is lithium cleared?
|
- cleared through the kidney, can be toxic
- dose medicine based on kidney function & also kidney function may decrease with prolonged use |
|
|
how do you treat the tremors lithium causes?
|
- beta blockers
|
|
|
how do you treat the polydipsia/polyuria & diabetes insipidus that lithium causes?
|
- using K-sparing diuretic & NSAID
- K-sparing diuretic: act on CD in nephron (same site lithium blocks ADH), this will block lithium receptor site & stop effects, can increase clearance of lithium - NSAIDs: vasoconstrict the kidney to counter the effects of lithium, but may impair lithium clearance so may go into toxicity |
|
|
what additional tests besides lithium serum levels should you look at to assess lithiums effects on body?
|
- thyroid, BUN, Cr
- electrolytes, calcium EKG to see markers for CVD function |
|
|
how many days do you wait until you look at blood lithium levels?
|
- 3-4 days to wait for it to get to steady state
|
|
|
what do ACE inhibitors, thiazide diuretics & NSAIDs do to lithium levels?
|
- ACE inhibitors & thiazide diuretics: used for lowering BP, can deplete sodium & water follows sodium, body reabsorbs lithium (b/c looks like sodium) so you can have toxicity
- NSAIDs: vasoconstrict kidney so can decrease clearance |
|
|
what can K sparing diuretics do to lithium levels?
|
- can decrease lithium levels
|
|
|
how do the anticonvulstants work as mood stabilizers (MOA)?
|
- work on VG ion channels involved in propagating AP
- enhance GABA receptor activity - decrease excitatory activity (glutamate or aspartate) |
|
|
what are some risks for using the anticonvulsants as mood stabilizers?
|
- CNS side effects
- potential increased risk for suicide - drug interactions (such as with phenobarbitol) |
|
|
what is the onset of action of valproic acid compared to lithium? therapeutic window?
|
- onset of action might be faster
- therapeutic window is narrow like lithium |
|
|
what are some side effects to valproic acid? what can you do to the pill to help these?
|
- main side effects: sedation, tremor, weight gain, NVD, platelet interactions (decreased)
- alopecia in some, neural tube defects (category D), increases in LFTs (but fatal hepatotoxicity has occurred) - can coat these to make it less harsh on GI system |
|
|
how are the anticonvulsants used as mood stabilizers cleared?
|
- cleared via hepatic metabolism
|
|
|
what is the difference between depakene vs depakote?
|
- depakotes are coated to make them less harsh on the GI system
- alternative to depakene - both contain valproic acid |
|
|
how does carbamazepine work? onset? therapeutic window?
|
- acts by stabilizing sodium channels
- may be quicker onset than Li - narrow therapeutic window |
|
|
what is the dangerous metabolite in carbamazepine? how does oxcarbazepine avoid this?
|
- epoxide metabolite
- has less P450 involvement & does not produce the epoxide metabolite |
|
|
what are some side effects of carbamazepine?
|
- NVD
- leukopenia, thrombocytopenia, rashes (HLA-B1502) w/ asians, hyponatremia - induces liver enzymes |
|
|
which anticonvulsant gives you SIADH?
|
- drug induce syndrome of inappropriate ADH
- carbamazepine - causes hyponatremia |
|
|
what are some side effects you see with lamotrigine?
|
- dizziness, ataxia, somnolence
- rashes: can be severe - stevens johnsons syndrome |
|
|
which anticonvulsant does not have a narrow therapeutic window?
|
- lamotrigine
|
|
|
which anticonvulsants are zero order drugs? first order?
|
- zero order are valproic acid & carbamazepine
- first order is lamotrigine |
