Ch. 49: Lithium and other mood stabilizers
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| drug of choice for treatment of bipolar disorder. considered a mood stabilizer. not sedative, euphoriant, or depressant. produces no effect in normal people | lithium
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| therapeutic index of lithiuM? | very low. very toxic. in fact, the therapeutic levels are only slightly lower than toxic amounts. thus, regular serum monitoring of lithium is required.
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| AE of lithium? | interferes with normal function of sodium ions to produce numerous changes in neurotransmitter activity in the brain. side effects are mostly due to increased elimination of potassium, secondary to drug's sodium ion effects.
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| most common side effects of lithium? | muscle tremor, ataxia, acquired diabetes insipidus, twitching, ataxia, seizures
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| what are some othe rmood stabilizers? | iamotrigine, topiramate, valproic acid, carbamazepine, gabapentin
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| this drug works to inhibit voltage gated sodium channels, prolonging the inactivated state of sodium channel. serves to prolong the relative refractory period. MOA in treatment of bipolar disorder remains unknown. | lamotrigine
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| AEs of lamotrigine? | stevens johnson syndrome, TEN. must e used with care with other medications since it demonstrates many drug interactions. also used to treat seizure disorder
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| works to enhance GABA activated chloride channels, alowing chloride entry into neurons and subsequent inhibition of neuronal activity. also has additional overall neuriinhibitory effects by modulating the kainite and AMPA receptors. also an Na chan blockr | topiramate
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| AE of topiramate? | headache, paresthesias, increased risk for upper respiratory infections, as well as weight loss and renal stones. believed that it causes renal stones because it also is a weak carbonic anhydrase inhibitor. also known to significantly decrease sweating
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| also used in treatment of bipolar disorder. its exact MOA is unkonwn, but studies show it increases the concentration of GABA in the brain. has large drug drug interactions. | valproic acid
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| valproic acid is contraindicated in which populatoin? | those with liver disease. also asociated iwth numerous side effects, including thrombocytopenia, gastrointestinal problems, risk for fatal hepatic failure, and risk for fatal pancreatitis. also used as an anticonvulsant.
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| has MOA similar to lamotrigine. | carbamazepine
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| AE of carbamazepine? | can be severe, and include steven johnson syndrome, TEN, migraines, cardiac arrhythmias,and bone marrow suppression. the latter often causes severe decrease in both white blood cell and platelet numbers.
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| carbamazepine can also cause.. | hepatitis and exacerbate hypothyroidism.
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| carbamazepine is DOC for treatment of.. | trigeminal neuralgia
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| a GABA analog, but despite its structural similary to GABA, it has no known effect on GBAA receptors. exact MOA unkown | gabapentin
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| proposed MOA of gabapentin? | believed that it may work by modulating GABA metabolism, reuptake, and release.
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| these are class C pharmeceuticals | lamotrigine, topiramate, gabapentin
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| these are class D pharmaceuticals | carbamazepine, lithium, valproic acid
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| drug that has uncertain safety when used in pregnant women | class C
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| drugs thta have been proven to be unsanfe in pregnant women | class D.
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| carbamazepine and valproic acid are renowned for causing... | neural tube defects (spinal bifida, anancephalus, rachischisis).
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| lithium can cause what heart anomaly? | Ebstein's anomaly
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| standard of practice in bipolar therapy | avoid monotherapy. instead, either two mood stabilizers are used together or one mood stabilizer and one atypical antipsychotic are used together. a common antipsychotic used for such combo therapy is aripiprazole.
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