What must you do before starting any mood stabilizers? Why?
- urine pregnancy test (UPT)
- all mood stabilizers are teratogenic
What labs should be monitored for patients on Lithium?
-renal function
BUN, Creatinine
What labs should be monitored for patients on carbamazepine?
-Liver function
AST, ALT, AP, LDH, Bili
What labs should be monitored for patients on Lamotrigine?
Trick question! no labs needed
What labs should be monitored for patients on oxcarbazepine?
Trick question! no labs needed
What is the mechanism of lithium?
-not clear
***inhibition of glycogen synthetase kinase 3 and protein kinase C
What does lithium treat?
- best for manic episodes
- also helps with depression, so its best for Bipolar disorders
Lithium is excreted with what ion in the kidneys?
**Sodium
-so if we change sodium in diet of pt on lithium, we can fuck with levels in body
What drugs should you avoid while on lithium?
NSAIDs
Why should NSAIDs be avoided in pts on lithium?
because of their effect on renal prostaglandin synthesis and sodium excretion
What are the major side effects of lithium?
teratogenic effects
What are the major side effects of mood stabilizers?
**teratogenic effects
=Ebstein’s anomaly (tricuspid valve defect)
What is Ebstein’s anomaly?
- caused by teratogenic effects of mood stabilizers
- tricuspid valve defect
Lithium = ______
Kidneys
How do we treat severe lithium toxicity?
dialysis
“pt with history of bipolar disorder and a coarse hand tremor” what do you do?
- send for lithium level labs
- start tx for lithium toxicity (fluids)
