mood stabilizers

Question 1

lithium resembles which other element?

Answer 1

sodium

Question 2

Role of lithium

Answer 2

• alters Na transport in nerve and muscle cells

Question 3

lithium is standard therapy for

Answer 3

mania and bipolar

Question 4

onset of lithium

Answer 4

may take days to weeks for full effect

Question 5

acute symptoms of disorders that require lithium might also require additional therapy from

Answer 5

benzodiazepines or antipsychotics

Question 6

lithium has a large or small therapeutic window

Answer 6

small window

Question 7

SE of lithium that is transient

Answer 7

nausea, diarrhea, fatigue

Question 8

SE of lithium with persistence

Answer 8

tremor, weight gain, polyuria, polydipsia

Question 9

lithium drug interactions:

those that increase lithium levels

Answer 9

• ACE inhibitors
• Diuretics like HTZ
• NSAIDs

Question 10

lithium drug interactions :

those that cause a decrease in lithium levels

Answer 10

• diuretics that are K-sparring

Question 11

valporic acid, carbamazepine and lamotrigine all belong to the family of

Answer 11

anti-convulsants

Question 12

anticonvulsants mechanisms (3)

Answer 12

1. modulation of voltageGIC involved in propagating the Action potential
2. enhancement of inhibitory activity: GABA
3. inhibition of excitatory activity: glutamate/aspartate

Question 13

SE of anticonvulsants

Answer 13

• CNS
• increased risk for suicide
• drug interactions

Question 14

role of valproic acid

Answer 14

• alternative to lithium; has FDA indication for mania and bipolar
• MOA: increased GABA levles

Question 15

onset of valproic acid?

what about therapeutic window?

Answer 15

ma be quicker than Lithium

• small therapeutic window

Question 16

black box warnings for valproic acid?

Answer 16

• neural tube defects
• fatal hepatoxicity
• pancreatitis

Question 17

role of Carbamazepine

Answer 17

• to those that are intolerant or unresponsive to LI/VA- FDA indication for mania and bipolar
• MOA: stabilizes sodium channels

Question 18

onset of carbamazepine?

therapeutic window?

Answer 18

• May be quicker than Li

narrow therapeutic window

Question 19

metabolism of carbazepine includes which nezym

Answer 19

CYP34A

Question 20

10,11-CBZ epoxide associated with

Answer 20

severe SE

Question 21

carbamazepine black box

Answer 21

• agrunolocytosis and aplastic anemia

- rashes (HLA-B1502)

Question 22

carbamazepine can promote the release of

Answer 22

ADH from the pituitary gland

Question 23

oxcarbazepine is a derivation of carbamazepine

what is the difference btw. them?

Answer 23

• less CYP450 involvment
• no 10,11 epoxide

-fewer overall SE

might be some higher hyponatremia SE

Question 24

black box warning from lamotrigine

Answer 24

rashes- importance of dose tritration

Question 25

A 33 yo patient with a history of bipolar disorder is currently treated with valproic acid after failing to tolerate lithium therapy. What should be monitored to ensure the safety of the current medication?

Answer 25

LFTs + amylase/ lipase