Mood Stabilizers

Lithium

MOA: Exact mechanism is unknown, but it is thought to alter neuronal sodium transport and influence the reuptake of serotonin and/or norepinephrine. Inhibits phosphoinositol recycling in the neurons, which affects mood

suicide

What does lithium reduce the risk of?

Bipolar disorder, mania

Along with schizoaffective disorder, what are two of the indications for lithium?

hyperparathyroidism, hypermagnesemia, nephrogenic, thirst, hypothyroidism, tremor, narrow

Lithium ADRs

-Endocrine: ______________, hypercalcemia, ____________, sodium depletion, AVP/ADH resistance (________ diabetes insipidus), increased ______, and _______________

-Neurologic: _______ is common, headache, seizures, sedation

-GI: nausea, vomiting, diarrhea, weight gain

-Cardiac: edema, arrhythmias, and EKG changes

-Heme: leukocytosis

-_______ therapeutic index

EKG, thyroid, CBC, 1.5, >

Lithium Monitoring

-Prior to initiating therapy, a basic ____, chemistries, _______ function, beta-hCG, and ____ should be performed.

-Levels should be checked after 5 days, then every 2-3 days until therapeutic. Monitor every 4-8 weeks after. Therapeutic range is 0.8-1.2. Levels may be toxic if > ____. EKG performed on initiation if _ 50 years old

Ebstein, increase, thiazides, Verapamil

Lithium Drug Interactions and Contraindications

-Pregnancy → associated with _______ anomaly if taken during the first trimester

-Severe renal disease → may ________ lithium levels

-Blood level is increased by dehydration, _______, tetracyclines, NSAIDs, ACEIs, and loop diuretics

-Blood level decreased by bronchodilators, _________, theophylline, and carbonic anhydrase inhibitors

Lamotrigine

MOA: Blocks Na and Ca channels, decreases presynaptic glutamate release. Inhibits glutamate’s effect on the NMDA receptor, reducing neuronal activity

dizziness, nausea, SJS

Lamotrigine ADRs

-__________, ataxia, _______, tremor, headache, ____, diplopia, and drug interactions

Valproic Acid

MOA: Potentiates GABA-mediated CNS inhibition, inhibits glutamate and NMDA receptors, increases refractory period of voltage-gated sodium channels, modulates Ca channels

drowsiness, alopecia, gain, hepatic, pancreatitis, neural tube, headache

Valproic Acid ADRs

-Common: __________ (sedation), nausea, tremor, hair loss (_______), weight _____, hepatotoxicity, and inhibition of ______ drug metabolism

-GI: ____________, hepatotoxicity, nausea, vomiting, weight changes

-Teratogenic: Valproate has the highest risk of birth defects of any antiepileptic drug. _______ _____ defects (like spina bifida) are the most common abnormalities seen after using valproate.

-Neurologic: ___________, sedation, tremor, ataxia, tinnitus, nystagmus, increased suicidality

-Nephro: hyponatremia due to SIADH

Liver enzymes

What should be monitored while the pt is on valproate?

Carbamazepine

MOA: Stabilizes neuronal membranes and stops seizure propagation by blocking voltage-gated sodium channels

dizziness, nausea, hepatotoxicity, depression, SIADH, SJS, Asians, agranulocytosis, craniofacial, heart failure

Carbamazepine ADRs

-Common: __________, drowsiness, ataxia, ________, vomiting

-GI: nausea, vomiting, anorexia, _____________ (monitor LFTs)

-Neurological: dizziness, ataxia, diplopia, CNS ___________, cognitive dysfunction

-Hyponatremia (causes _______)

-____ (test for HLA-B*1502), which is a genetic susceptibility marker in _______ associated with an increased risk of developing SJS

-Blood dyscrasias: ____________, aplastic anemia, thrombocytopenia

-Teratogenic potential: _________ abnormalities (cleft lip/palate), spina bifida, CV malformation, hypospadias

-Cardiac: Can exacerbate ______ ________

lupus, CBC

Monitoring Carbamazepine

-Watch for signs of drug induced _____

-Monitor LFTs and ___