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30 terms

Pharm ~ Neuro: Mood Stabilizers

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Mood Stabilizers
Lithium
Carbamazepine
Oxcarbazepine
Valproic Acid
Lamotrigine
Lithium
effective for manic phase and long term maintenance
stabalizes mood without causing sedation
effect starts in days; full effect 2-4 weeks
Lithium - Mechanism of Action
unknown
Lithium - with Depression
can be given with an SSRI or buproprion during a depressive episode
Lithium- Side Effects
N, D, Wt gain, polyuria, tremor, hypothyroidism
must maintain hydration and sodium intake
Lithium - Drug Interactions
Increase Lithium Levels:
-dehydration
- ACE inhibitors (captopril, enalipril)
-metronidazole
-NSAIDS
-thiazide diuretics, phenothiazides, haloperidol, fluoxetine
Decrease Lithium Levels
- calcium channel blockers
-theophyline -> inc. excretion of Li
Increased Neurotoxicity
- antipsychotics
-SSRIs
-haloperidol and NMS
Lithium - Mild Toxicity
mild (early; over days): 1.5-2mEq/L
-ataxia, course tremor, confusion, diarrhea, drowsiness, muscle twitches, slurred speech
TX: hold doses, assess S&S, Li level, VS, Pt education, rehydration
Lithium - Mod/Severe Toxicity
>2mEq/L
- gradual or sudden onset
-muscle tremor, hyperreflexia, irregular pulse,hyper or hypoTN, EKG changes
-visual/tactile hallucinations, oliguria/anuria, seizures, coma, death
TX:
-hold all doses
-Assess S&S, Li level, VS, LOC, ABCs, metabolic labs, CBCdiff, EKG
-hydration, gastric lavage, hemodialysis
Lithium - Advantages
used 40 yrs
standard for euphoric and hypomania
maintenance and prophylaxis
may be more protective for suicidality during episodes than Valproic Acid
use alone or with SSRIs
inexpensive; variety of doses
Lithium - Disadvantages
labs (renal, thyroid, cardiac, CBCdiff, lytes)
slow onset of effect
narrow therapeutic index
++ S/E
Carbamazepine (Tegretol, Tegretol XR)
anticonvulsant that can be used to treat acute mania or prophylactic for mania
- works well for rapid cyclers
-autoinducer
- mechanism of action unknown
Carbamazepine - toxicity
- therapeutic range: 4-12 ug/ml
toxicity: > 8ug/ml
N,V,L, dizzy, drowsy, HA, blurred vision, diplopia, ataxia
-common with abrupt dosing changes
Carbamazepine - Side Effects
- blood dyscrasias (thrombocytopenia, leulopenia,
rare aplastic anemia
- Skin: Stevens-Johnson Syndrome
- Hyponatremia (esp. elderly)
- Cognitive effects: sedation, ataxia, dizzy
- Neuromuscular effects
Carbamazepine - Drug Interactions
Increase levels:
- calcium channel blockers, cimetidine, erythromycin
valproate
Decrease Levels:
- phenobarbitol
Carbamazepine causes decreased level/effect for:
- hormonal contraception
- theophylline
- warfarin
Carbamazepine - Advantages
- mgt of epilepsy and paroxysmal disorders
- more rapid onset than lithium; may be more effective for mixed mania and rapid cyclers
- generally well tolerated
Carbamazepine - Disadvantages
- auto inducer (stimulates its own oxidative
metabolism
- drug interactions
- labs: CBCdiff, liver and renal fcn
Oxcarbazepine (trileptal)
mono or adjuntive therapy for partial seizures in adults
adjunctive therapy for partial seizures in children

UNLABELED USE: Acute mania, atypical panic disorder
Oxcarbazepine (trileptal) - Mechanism Action
unknown
derrivative of Carbamazepine
Oxcarbazepine (trileptal)- Side Effects
dose dependent: N, HA, drowsy, dizzy, ataxia, tiredness
Idiopathic: hyponatremia, rash, wt gain
Oxcarbazepine (trileptal) - v. Carbamazepine
no lab monitoring
metabolic s/e
decreases effectiveness of hormonal BC
Valproic Acid (Depakote)
anticonvulsant; approved for use in mania and mixed bipolar states
-useful for rapid cyclers
Lamotrigine (Lamictal)
- monotherapy for generalized seizures in adults and
children
-adjunct therapy to partial seizures (refractory)
-maintenance mood stabilizer in BP 1 Depression
UNLABELED USE: Mood stabalized in rapid-cycling bipolar II
Lamotrigine (Lamictal) - Mech. Action
inhibits release of glutamate
Lamotrigine (Lamictal) - Adverse Effects
dizzy, HA, diplopia, ataxia, N, blurred v, somnolence, skin rash
BLACK BOX: Steven Johnson Syndrome
upgraded to Pregnancy C
Topiramate (Topamax)
partial and complex seizures
NOT bipolar disorder
no studies on efficacy or safety in mood dx
may be useful in resistant pts with comorbid substance abuse and impulse control disorders
Topiramate (Topamax)- Adverse Rxns
somnolence, dizzy, vision, unsteady, nervous, N
HTN crisis
extreme increases in body temp (NMS)
GABApentin (Neurontin)
complex partial seizures
generalized seizures
neuropathic pain
NOT affective for bipolar disorder
Atypical Antipsychotics for Bipolar Disorder and Psychosis
acute treatment and prohylaxis
Atypical Antipsychotics- Mechanism of Action
- enhances 5-HT and NE -> reduces symptoms of mood and anxiety
-antagonize 5-HT and alpha-2 adrenergic receptors to varying degrees
Atypical Antipsychotics - monitoring
wt gain
obesity
type II diabetes
metabolic syndrome