Term
Lithium
First line indications for use? (3)
Second line? (3)
When is it used in Depressed patients?
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Definition
First line for:
Classic euphoric mania
Pure bipolar depression
Bipolar maintenance
Second Line:
Mixed mania (simultaneous features of mania & depression)
Rapid cycling
Also used for depression augmentation for suicide prevention
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Term
What are 2 general Management issues with Lithium administration
(provide 4 specific D-D interactions)
What causes alteration of lithium levels in the blood?
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Definition
Management issues:
Requires blood monitoring
- Blood level
- Serum creatinine
- TSH levels
Has significant drug-drug interactions
- NSAIDs
- Thiazide diuretics
- ACE Inhibitors
- Ca channel blockers
(can all raise serum Li levels)
Lithium is a salt that gets processed by the kidney, so other things that affect kidney function will alter serum lithium levels
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Term
Lithium: Reasons for non-compliance
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Definition
Side effects
decreased creativity/productivity
indefinite intake
felt well, no need to continue
Miss the highs, feel less interesting
Don't like the idea of mood being 'controlled'
Felt depressed, thought mood would improve off medication
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Term
Anticonvulsants
What is the Mech/Theory behind their use in treating BPD?
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Definition
'Kindling' theory: common episodic nature between seizures and BPD; idea is that low level stim, subthreshold, can provide the kindling to ignite a full-blown seizure, so anticonvulsants were given to BPD patients in hopes to remove the kindling that ignite manic episodes
Proposed mech: Block Na/Ca channels, boosting GABA inhibition and decreasing Glu excitation
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Term
Valproic Acid/Valproate
What are its first and second line indications? (2 for each)
Specific therapeutic advantage it has over lithium? |
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Definition
(its an anticonvulsant), aka Depakote/Depakene
1st line:
Mixed mania
Rapid cycling
2nd line:
pure depressive states
classic euphoric mania
Valproic Acid can be rapidly loaded for quicker therapeutic effect, can quickly stabilize an episodic person |
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Term
| How do the management issues of Valproic Acid compare to that of Lithium? |
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Definition
Very similar
Requires blood monitoring (but checks diff things than for lithium: liver function, serum amylase, and complete blood cell count)
Also has significant drug-drug interactions
Wider therapeutic index than lithium |
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Term
Valproic Acid
Adverse Affects (5 categories)
vs. Serious Adverse affects (6) |
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Definition
1. GI - nausea/vomiting/diarrhea
2. Sedation, lightheadedness, tremor
3. Cognitive blunting
4. increase appetite/weight gain
5. Hair loss
Serious adverse affects:
1. Thrombocytopenia (monitor blood)
2. Hepatotoxicity
3. Pancreatitis
4. Polycystic ovarian syndrome in young women
5. Teratogenicity (NTDs)
6. Overdose risk
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Term
Carbamazepine
Mech of action?
Indications?
How do its Adverse affects differ from those of Valproic Acid? |
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Definition
aka Tegretol; very similar to Valproic acid:
Mech not fully understood, related to Na/K channels, once again enhancing GABA inhibition
Used for BPD mixed mania and rapid cycling (same as valproic acid)
Most of the same adverse affects, but causes electrolyte abnormalities and anticholinergic effects as well |
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Term
Carbamazepine
Serious side effects (5) |
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Definition
1. Hematologic (thrombocytopenia, but also agranulocytosis and aplastic anemia)
2. Hepatotox
3. Allergic rxns/rash
4. Teratogenicity (NTDs, craniofacial abnormalities)
5. Overdose risk again |
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Term
Carbamazepine
Compare its Management Issues with those of Li/Valproic Acid |
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Definition
Blood monitoring again, all the same except examine serum electrolytes here
Drug-drug interactions: It induces the cytochrome p450 system, actually causing decreased levels of many other meds and itself! (normally drugs interact by competing and keep each others serum levels higher for longer) |
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Term
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Definition
Metabolite of cabamazepine
Has fewer drug interactions and toxicities
Does not require blood monitoring |
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Term
Lamotrigine
Mech and Indications
Adverse effects?
Serious adverse effect? (1 really)
How do you prevent this? |
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Definition
Mech: unclear, inhibits Na --> inhib Glu
Especially helps BPD patients w/ their depressive phases; FDA approved for bipolar maintenancde
All the same less severe side effects as the other anticonvulsants, symptoms are less severe w/ Lamotrigine
Severe:
Rash (affects 8-10%), fairly common in benign
..but can progress to Steven Johnson Syndrome - a potentially life-threatening rash that can affect multiple organs
Must slowly/carefully titrate drug, the rash is correlated w/ a rapid increase in dose
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