PMHNP Clinical Study Cards: Mood Stabilizers & Bipolar Treatment

Vocabulary-style study flashcards covering mood stabilizers (lithium, lamotrigine, valproate, carbamazepine), adverse effects, laboratory monitoring, and bipolar clinical decision-making.

Lithium

A classic mood stabilizer with clinical evidence supporting suicide-risk reduction in bipolar illness.

Lamotrigine (Lamictal)

An antiseizure mood stabilizer FDA-approved for the maintenance treatment of bipolar I disorder to delay mood episodes, but not approved for acute mania.

Baseline lithium evaluation

Clinical workup required prior to initiating lithium therapy, including renal function, electrolytes, thyroid function, pregnancy potential when relevant, and a review of medications and drug interactions.

12-hour trough (Lithium)

The standard timing for drawing lithium serum blood concentrations to maintain consistency and align with regimen and clinical guidance.

Lithium level interpretation

The clinical evaluation of lithium serum concentrations that must always take into account timing, formulation, dose changes, renal function, and presenting clinical symptoms.

Factors increasing lithium concentration

Physiological states and medications that raise lithium levels, notably dehydration, sodium depletion, NSAIDs, thiazides, ACE inhibitors, and ARBs.

Lithium toxicity

A toxic clinical state characterized by worsening tremor, vomiting, diarrhea, ataxia, confusion, or neurologic deterioration.

Long-term lithium monitoring

Ongoing laboratory monitoring of kidney function, thyroid function, and calcium or parathyroid effects during chronic lithium therapy.

Lithium gastrointestinal fluid loss warning

The clinical risk where severe vomiting or diarrhea causes fluid and sodium depletion, thereby elevating lithium exposure and increasing toxicity risk.

Slow lamotrigine titration

The gradual dosage escalation protocol required for lamotrigine to minimize the risk of serious rash, including Stevens-Johnson syndrome.

Valproate-lamotrigine interaction

A drug interaction in which valproate inhibits lamotrigine metabolism, markedly raising lamotrigine blood exposure and necessitating an altered titration regimen.

Estrogen-containing contraceptive interaction with lamotrigine

An interaction where estrogen-containing contraceptives often reduce lamotrigine serum concentrations, requiring dose reassessment upon initiation or discontinuation.

Lamotrigine rash management

The clinical recommendation for urgent assessment and medication discontinuation at the first sign of a concerning rash unless it is clearly unrelated.

Lamotrigine missed-dose protocol

The clinical directive to determine whether restart titration is necessary rather than resuming the full prior dose if doses have been missed for several days.

Valproate formulations

A mood stabilizer chemical entity also referred to as valproic acid or divalproex sodium, depending on the product formulation.

Valproate laboratory monitoring

Laboratory assessments commonly performed for valproate therapy, including liver function tests, CBC with platelets, drug levels, and ammonia when clinically indicated.

Valproate teratogenicity

The high risk of fetal anatomical malformations and neurodevelopmental adverse effects associated with valproate exposure during pregnancy.

Valproate serious adverse effects

Severe medical complications of valproate treatment, including hepatotoxicity, pancreatitis, thrombocytopenia, and hyperammonemia.

Carbamazepine autoinduction

A prominent pharmacokinetic property of carbamazepine involving potent hepatic enzyme induction of other drugs as well as its own metabolism, leading to numerous drug interactions.

Carbamazepine laboratory monitoring

Baseline and periodic laboratory evaluations required for carbamazepine, specifically CBC, liver function, and sodium levels.

HLA-B*1502 screening

Genetic testing indicated prior to starting carbamazepine in at-risk ancestry populations to evaluate the risk of Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN).

Acute mania pharmacotherapy

Medication classes used in the management of acute mania, consisting of lithium, selected antiseizure mood stabilizers, and/or antipsychotics depending on presentation severity.

Antidepressant monotherapy in bipolar I depression

A contraindicated treatment strategy that carries significant risk of precipitating mania or destabilizing mood.

Hydrochlorothiazide-lithium interaction

A drug interaction wherein the addition of hydrochlorothiazide can increase lithium blood concentrations, necessitating prompt prescriber coordination, monitoring, and potential dosage adjustments.

Valproate-induced pancreatitis presentation

A severe adverse complication that must be urgently assessed when a patient on valproate presents with severe abdominal pain and vomiting, rather than assuming ordinary gastrointestinal upset.