Question:
Lithium
Answer:
-Mood stabilizer
-Works equal or better than Valproate in Bipolar d/o
,-Decreases SI in Bipolar d/o
-Not great for rapid cycling (> 4 X per year).
-not protein bound & is renally excreted
• Elderly have more difficulty with this drug given their decreased renal
function
-Monitor:
• CR, TSH, CBC, EKG, Li levels
-Know baseline:
• thyroid function & renal function prior to use.
• Pregnancy test prior to initiation
-Avoid breast feeding with use.
-Side Effects:
• Weight gain
• tremor
• hair loss
• decreased cognition
-Narrow therapeutic window
• Maintenance at 0.6 - 1.0
• Early signs of toxicity over 1.5
➣Symptoms may include tremor, N/D, blurred vision, confusion
,Question:
Lamotrigine
Answer:
-Anticonvulsant
-Mood stabilizer
-Helps with Bipolar Depression
• is an off label use
-Rare but deadly side effect of Steven-Johnson Syndrome
Question:
Carbamazepine
Answer:
-Anticonvulsant
-Mood stabilizer
-Induces its own metabolism
-Steven-Johnson syndrome risk elevated in patients of Asian decent
• Genetic screening recommended
-Notable CYP3A4 inducer
, Question:
Valproate
Answer:
-Anticonvulsant
-Mood stabilizer
-Contraindicated in pregnancy
• associated with neural tube defects
-Side effects:
• potential hepatotoxicity
• pancreatitis
• weight gain
• dose dependent thrombocytopenia
-Highly protein bound
-Therapeutic range for mania= 50 - 125 mcg/mcl with a target of 80 mcg/ml
-Monitoring:
• LFTs, CBC with platelets, Serum Ammonia with MS change, serum valproate
level
Question:
Antipsychotics: 1st generation
Answer:
-D2 antagonism
• MOA & reason for many of the side effects
-Result of D2 receptors being blocked in pathways:
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