Comprehensive Study Notes: Psychiatric Pharmacology and Mood Stabilizers

Examination and CMS Module Discussion

• The study group clarified the status of the CMS (Content Mastery Series) modules.

• It was initially thought there was a CMS for Pharmacology (Pharm).

• A group member double-checked the modules and confirmed that the CMS is only for Fundamentals and Mental Health, not for Pharmacology.

• The group expressed relief, noting that while they performed well in Pharmacology, not having a CMS for it was a significant weight off their minds.

Phenylazine (Phenelzine) - MAOI Therapy for Atypical Depression

• General Overview:

  • Phenylazine is classified as an MAOI (Monoamine Oxidase Inhibitor).

  • It is specifically used for patients with severe or atypical depression symptoms.

  • It is typically reserved for patients who are unresponsive to or have a high resistance to other antidepressant drugs.

• Irrevocable Mechanism:

  • Phenylazine irrevocably blocks Monoamine Oxidase (MAO).

  • Because the block is irrevocable, the patient cannot easily modify their physiological behavior until new enzymes are created.

• The "Ben/Ryan" Metaphor (Mnemonic for Resistance):

  • The speaker (Renata) compares the drug to her ex-husband, Ryan (also referred to as "Ben" or "Rifen").

  • Just like the drug is for "difficult to treat" cases, Ry/Ben was difficult and resistant to change.

  • "Life-saving" mnemonic: Thinking of a "shitty ex-husband" helps retain these drug details.

• Dietary Restrictions and Strict Rules:

  • Patients on Phenylazine must follow strict food and medication rules.

  • Avoid:

  • Salty foods.

  • Aged foods (metaphor: "the older they get, the saggier they get").

  • Cured foods.

  • Fermented foods.

  • Alcohol/Drinks.

• Side Effects and Adverse Reactions:

  • Physical Changes: Significant weight gain (metaphor: losing $75$ pounds later on GLP-1s caused extreme skin sagging, likened to coming out of a "Gravitron").

  • Gastrointestinal/Systemic: Dry mouth, constipation, nausea, and edema.

  • Neurological/Psychological: Insomnia, tremors, mania, and suicidal thoughts.

  • Sexual Health: Sexual dysfunction; the transcript mentions the use of Viagra as a potential indicative factor.

  • Severe Symptoms: Sweating, stiff neck, and Serotonin Syndrome.

Valproic Acid (Depakote) - Antiepileptic and Mood Stabilizer

• Drug Class and Indications:

  • Classified as an antiepileptic used as a mood-stabilizing medication.

  • Primary use: Treatment of acute manic episodes in Bipolar $1$ (Bipolar I) and maintenance therapy.

  • Effective for delaying the future onset of depression or mania.

• Mechanism of Action:

  • Increases GABA levels in the brain.

  • Mnemonic: "Gabby is doing yoga," which helps stabilize nerve activity and mood.

• Contraindications and Toxicity:

  • Liver function: It is extremely toxic to the liver. Severe liver disease is a major contraindication.

  • Pancreatitis: It can cause pancreatitis. This occurs when enzymes get stuck in the pancreas and begin to "eat" the organ itself because they are programmed to eat once the "clock ticks."

• Side Effects:

  • Tremors, drowsiness, dizziness, and weight gain.

  • Physical state: Can make a patient feel like a "zombie" or in a "coma."

• Laboratory Monitoring and Risks:

  • Requires frequent monitoring of lab values.

  • Ammonia: Causes hyperammonemia (increased ammonia levels).

  • Thrombocytopenia: Causes low platelet counts (thrombocytopenia).

  • Pregnancy/Fetal Harm: High risk of major fetal harm, specifically neural tube defects. An example provided is Spina Bifida.

Lamotrigine - Mood Stabilization and Safety Protocols

• General Use:

  • Often used for Bipolar $1$ (Bipolar I) maintenance to delay the future of depression and mania.

• Contraindications and Precautions:

  • Hypersensitivity: Known history of hypersensitivity or severe drug rashes.

  • Renal and Hepatic Impairment: Requires extreme precaution.

  • Suicidal Ideation: Monitoring for suicidal thoughts is necessary.

  • Pediatric Patients: There is a higher incidence of life-threatening rashes in pediatric populations.

• Stevens-Johnson Syndrome (SJS):

  • A major risk of Lamotrigine is the development of a severe rash known as Stevens-Johnson Syndrome.

  • Clinical Instruction: Instruct the client to monitor for rashes and discontinue the medication at the very first sign of a rash.

• Drug-Drug Interactions:

  • Valproic acid should not be taken with Lamotrigine because Valproic acid doubles the levels of Lamotrigine in the body, increasing the risk of toxicity.

Lithium Carbonate (Lithium) - Therapeutic Management

• Absorption and Mechanism:

  • Absorbed in the GI tract.

  • Alters sodium transport.

  • Decreases the release of norepinephrine and dopamine (associated with happy mood and focus).

• Clinical Indications:

  • Used to treat manic episodes and reduce the frequency and intensity of future bipolar episodes.

  • Stabilizes mood elevation, agitation, and overactivity (Note: It does not sedate every patient immediately).

• Salt and Sodium Interaction:

  • Lithium has a unique relationship with sodium.

  • Mnemonic: "Lithy loves sodium." She will "go to town on some Doritos or potato chips."

  • Requirement: Sodium intake must remain consistent. Significant changes in sodium levels can affect Lithium levels.

• Side Effects:

  • Fatigue, sleepiness, hand tremors, and thirst.

• Therapeutic Levels and Toxicity:

  • The therapeutic range is $0.6$ to $1.2$.

  • If the level is below $0.6$: Increased risk of seizures.

  • If the level is above $1.2$: Increased risk of toxicity.

• Monitoring Requirements:

  • Kidney function (Renal).

  • Thyroid function.

  • Electrolyte levels.

• Drug Interactions:

  • Drugs that raise Lithium levels: NSAIDs, Thiazide diuretics, and ACE inhibitors.

  • Bleeding Risks: Aspirin and Warfarin can increase the risk of bleeding when combined with Lithium therapy.

Questions & Discussion

• Discussion on Complex Terms:

  • Question: "What is thrombocytopenia again?"

  • Answer: It refers to low platelets. The suffix "-penia" indicates a small or slow amount, and "thrombo-" relates to clotting; since platelets cause clotting, a deficiency is thrombocytopenia.

• Family Anecdotes and Personal Connections:

  • One speaker shared a story about her family history, involving a grandfather who remarried a "horrible human" who was a raging alcoholic and shopaholic.

  • This personal context was discussed in relation to managing family affairs and the lack of time to date due to school and caring for children.

• Study Strategy:

  • The group decided to take a break from Pharmacology to quiz each other on Mental Health materials.

  • One student expressed fear regarding the Mental Health exam and sought to "finesse" the material through group quizzing.

  • Plans were made to watch "Nurse Mike" videos the following day for further reinforcement.