Question

Make a chart as listed in your text of the mood stabilizing agents. Know the names, contraindications/precautions. Lithium is the gold standard for mood disorders but not all patients can take this drug. Be familiar with it and its narrow drug range and drug withdrawals. What are "acceptable" side effects of taking Li+? You will notice many of these drugs have "unlabeled" uses such as for migraine management, etc

Answer 1

Mood stabilizing agents	contraindications
Lithium carbonate	1) pregnancy 2)Renal failure 3)CVS insufficiency 4)Addison's disease 5)Untreated hypothyroidism
Sodium valproate	1) known hypersensitivity to the drug 2) patient with urea cycle disorder 3)Active liver diseases 4) family history of liver disease 5) porphyria
Carbamazepine	1) Atrioventricular block 2) Porphyria 3)bone marrow suppression
Lamotrigine	1)known hypersensitivity to the drug 2)Renal failure 3) Meningitis

*There is marked individual variation in the rate of lithium excretion.thus ,with the same daily dose, different individuals attain widely different plasma concentrations.However,in any individual the clearance remains fairly constant over time.

*Since the margin of safety is narrow, monitoring of serum lithium concentration is essential for optimising therapy.serum lithium level is measured 12 hours after the last dose to reflect the steady state concentration; 0.5-0.8 mEq/L is considered optimum for maintainance therapy in bipolar disorder,while 0.8-1.1 mEq/L is required for episode of mania.Toxicity symptoms occur frequently when serum levela exceed 1.5 mEq/L.

*Lithium immediately withdraw when there is CNS toxicity.

Acceptable side effects of lithium.

1)Nausea, vomiting and mild diarrhoea occur initially,can be minimized by starting at lower doses.

2)Thirst and polyuria are experienced by most,some fluid retention may occur initially,but clear later.

3)fine tremors are noted even at therapeutic concentration.