MOOD STABILIZERS

Question 1

MOOD STABILIZING DRUGS

Answer 1

• Lithium
• Anticonvulsants

Question 2

INDICATIONS

Answer 2

Mnemonic: “Bi-MAN”

Bi – Bipolar disorder
MAN – Acute mania

Question 3

MECHANISM OF ACTION

Answer 3

Lithium – “Li BALANCE”
👉 Balances brain chemicals
* Serotonin
* Norepinephrine
* Acetylcholine
* Dopamine
🟢 Gold standard for bipolar disorder
⚠️ Requires close blood level monitoring

Question 4

increase GABA level

Answer 4

Valproic Acid and Topiramate

Question 5

stabilize mood through KINDLING PROCESS (snowball like effect that raises the level of threshold to minor manic episodes, thus, preventing full blown mania)

Answer 5

Valproic and Carbamazepine

Question 6

the gold standard for the treatment of bipolar disorder

Answer 6

Lithium

Question 7

Therapeutic serum level

Answer 7

0.6-1.2 mEq/L

Question 8

Mild to moderate toxic reactions

Answer 8

1.5-2 mEq/L

Question 9

Moderate to severe toxic rxn

Answer 9

2-3 mEq/L

Question 10

LITHIUM TOXICITY

Answer 10

Mnemonic: “D-V DMC”
* D – Diarrhea (severe)
* V – Vomiting
* D – Drowsiness
* M – Muscle weakness
* C – Coordination loss → Coma
death if serum level is >3 mEq/L

Question 11

LITHIUM SIDE EFFECTS

Answer 11

Mnemonic: “LITHIUM MAKES YOU FAT & THIRSTY”
* L – Lethargy
* I – Increased thirst (polydipsia)
* T – Tremor (fine hand)
* H – Heavy fatigue
* I – Increased urination (polyuria)
* U – Upset stomach (nausea, diarrhea, anorexia)
* M – Metallic taste
➕ Weight gain

Question 12

CARBAMAZEPINE & VALPROIC ACID

Answer 12

• Sedation / drowsiness
• Dry mouth
• Blurred vision

Question 13

Extra Effects of Carbamazepine

Answer 13

RASH + Orthostatic hypotension

Question 14

Extra Effects of Valproic Acid

Answer 14

Weight gain, alopecia, tremor

Question 15

TOPIRAMATE SIDE EFFECTS

Answer 15

• Dizziness
• Sedation
• Weight loss
• Increase incidence of renal calculi

Question 16

MANAGEMENT

Answer 16

Mnemonic: “LEVEL–MEAL–NO DRIVE”

• LEVEL → Monitor blood levels
  o Draw 12 hours after last dose
• MEAL → Take with food (↓ nausea)
• NO DRIVE → Until dizziness, fatigue, blurred vision resolve

Question 17

Toxic Effects to watch out for: FOR VALPROIC ACID

Answer 17

“LIVER–BABY–PANCREAS”

Hepatic failure → LFTs before & during therapy

Birth defects → Neural tube defects (spina bifida)

Pancreatitis

Question 18

Toxic Effects to watch out for:
CARBAMAZEPINE

Answer 18

“NO BLOOD”

• Aplastic anemia
• Agranulocytosis
• Monitor WBC & platelets

Question 19

Toxic Effects to watch out for:

LAMOTRIGINE (Lamictal)

Answer 19

“BAD SKIN” ⚠️
* Stevens-Johnson Syndrome
* Toxic epidermal necrolysis
* Higher risk in children <16