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Mood Stabilizer

Pharmacology

QuestionAnswer
Manic Episodes -elevated, expansive, or irritable for at least 1wk -grandiosity, decrease in need for sleep, more talkative, racing thoughts, distractibility, increased agitation, excessive risk-taking
Hypomanic Episodes for at least 4 days -same symptoms as manic epidodes -no marked impairment/hospitalization/pscyhosis
Mixed State -mix of manic and depressed -depressed: 1 of these: depressed mood, decr. interest/pleasure plus 4 of these: change in weight/appetitem, insomina, agitation, fatique, guilt, decr.ability to think. thougths of death
Drug for bipolar disorder: the mood-stabilizing agents LVCL-Lithium, valproic acid(Depakote; Depakene), carbamazepine (Tegretol), lamotrigine (Lamictal) -not effective alone in major depression -effective against both manic and depressive stages of bipolar -Teratogenic esp. 1st trimester
atypical neuroleptics in bipolar disorder risperidone, ziprasidone, olanzapine, quetiapine, asenpaine, aripirazole
lithium effective initially, but wears off-need a substitution or addition of Rx -predictors of poor response: rapid cycles, family Hx, Hx of drug abuse, mixed state
Acute Treatment with lithium -1-2wk latency -neuropleptic often combined; BZD for first few weeks -0.8-1.5mEq/L (blood level); 2+ mEq/L (toxic) low therapeutic index drug-potential cardiotoxicity
chronic treatment with lithium first agent for maintenance -therapeutic range=0.6-1.2 mEq/L -may need to add neuroleptic, anticonvulsant, or antidepressant -watch for adverse effect -lifetime Rx is prob. required
adverse effect of Li -category D for preg: congential cardiac malformations in 1st trimester -diarrhea, disturbances in fluid homeosasis (edema, thirst, urinary frequency) -decr. in thyroid hormone secretion
acute toxic of Li 2.0mEq/L in young adults 1.5mEq/L in elderly -NV -cardiac arrythmias, conduction deficits -renal failure
adverse drug interactions with Li plasma Li level increase & decrease renal clearance -thiazide diuretics, ACE inhibitors, NSAIDS
Valproic Acid -as effective as lithium for acute mania (alternative to Li) -sodium valproate or divalproex -pregnancy D: neural tube defects -effective in maintenance +/- lithium or neuroleptic
Carbamazepine -acute mania in some lithium non-responders -effective in maintenance +/- lithium or neuropletic -Major Advese: sedation, N/V, pancytopenia -hypersensitivity/ rashes -pregnancy D: cleft lip, palate, facial dysmorphias
Lamotrigine effective alone in bipolar depression but NOT MANIA effective in maintenance (+ lithium)-mainly used for maintenance -slow titration needed - no effect on acute mania -ADVERSE: sedation, Stevens-Johnson (rashes) -pregnancy "C"
mechansims not clear; but they are all sodium blockers, we don't know why other Na blockers don't work
Created by: Eunj