Psychotherapy: 107b - Mood Stabilizers

Lamotrigine

10% get benign rash, 1% get SJS

• Acutely:
  

  • GI symptoms

• How is lithium toxicity managed?

  • Stop lithium

  • Rehydrate w/ normal saline (mild)

  • What might cause a patient previously doing well on Lithium to develop lithium toxicity?

    • Dehydration

    • Decreased Na+ intake
      

      • What are the key differences between antidepressants and mood stabilizers?

        Both work to treat and prevent depressive episodes

        • Mood stabilizers als...

    View all 13 terms

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  Psychotherapy: 107b - Mood Stabilizers

  Term	Definition
  What is the MOA of Li?	Acts via intracellular signal transduction to alter the activity of several neurotransmitters Not well understood No synaptic action
  What are the indications for lithium?	Mania But can take 1-3 weks to see full affect Not used alone for acute episodes Maintenence treatment for bipolar disorder More effective at preventing manic vs. depressive episodes Bipolar depression Better for bipolar depression than most other mood stabilizers Decreases risk of suicide
  What fetal malformatio is associated with lithium?	Ebstein’s anomaly (Dysplastic tricuspid valve)
  In general, what is the mechanism of AEDs?	Increased inactivation of voltage-gated Na+ channels Results in increased GABA, decreased glutamate activity
  Which drugs can be used to treat acute mania?	Valproic acid Works quickly Carbamazepine Lithium Does not act quickly; not used as monotherapy Antipsychotics Especially 2nd generation
  Which medications can be used to treat manic episodes AND for Bipolar disorder maintenence therapy?	Lithium Valproic acid Carbamazepine
  Which AED can be used as maintenance therapy for bipolar disorder, but not to treat acute manic episodes?	Lamotrigine
  Which mood stabilizers are most effective in the treatment of bipolar depression?	Lithium Lamotrigine 2nd generation antipsychotics Valproic acid, carbamazepine can be used in acute mania and maintenance, but are not as effective for bipolar depression
  Which AED carries the lowest risk of sedation and weight gain? What side effect IS associated with this agent?	Lamotrigine 10% get benign rash, 1% get SJS
  What are the symptoms of Lithium toxicity?	Acutely: GI symptoms Chronically Neurologic: tremor, ataxia Renal Cardiac
  How is lithium toxicity managed?	Stop lithium Rehydrate w/ normal saline (mild) Dialysis if severe
  What might cause a patient previously doing well on Lithium to develop lithium toxicity?	Dehydration Decreased Na+ intake Results in increased Li absorption Decreased renal blood flow Intrinsic renal disease, heart failure, cirrhosis
  What are the key differences between antidepressants and mood stabilizers?	Both work to treat and prevent depressive episodes Mood stabilizers also treat and prevent manic episodes And treat depressive episodes without precipating mania Antidepressants can precipitate manic episodes And do not work to treat manic episodes