Mood Stabilizers/Pharmacology
Summary
TLDRThis video script delves into the realm of mood stabilizers, focusing on their role in managing bipolar disorder. It introduces five key medications: lithium, valproic acid, lamotrigine, carbamazepine, and oxcarbazepine, and their specific applications for manic or depressive episodes. The script highlights the importance of understanding the 'two poles' of bipolar disorder and how it influences medication choice. It also emphasizes the significance of recognizing adverse drug reactions, which often form the crux of exam questions, providing insights into the clinical application of this knowledge beyond test-taking.
Takeaways
- 💊 Mood stabilizers are a group of drugs primarily used to treat different aspects of bipolar disorder.
- 🌐 Bipolar disorder has two poles: the manic and depressive poles, and patients can experience episodes of either.
- 🤔 It's important to distinguish bipolar disorder's depressive episodes from major depressive disorder, as treatment differs.
- 💡 The test writer's portrayal of a patient's bipolar episode (manic or depressive) can influence the correct answer on exams like USMLE and COMLEX.
- 🌟 Lithium is the gold standard treatment for the manic phase of bipolar disorder.
- 🌿 Lamotrigine is the preferred treatment for the depressive phase of bipolar disorder.
- 🔄 Valproic acid is used for mixed or rapid cycling bipolar disorder where patients experience alternating mania and depression.
- 💡 Carbamazepine and oxcarbazepine are used when other mood stabilizers are not effective.
- 🧠 Lithium's mechanism of action involves modulation of the phospholipinositol pathway, which is important for exams.
- ⚠️ Adverse drug reactions and precautions are crucial to understand, as they are frequently tested and can be severe.
- 📚 Understanding the adverse reactions of mood stabilizers can help in clinical practice and on exams, emphasizing the need for careful monitoring.
Q & A
What are mood stabilizers and why are they important in the context of bipolar disorder?
-Mood stabilizers are a group of drugs used to treat different aspects of bipolar disorder. They are crucial because they help manage the extreme emotional states characteristic of the disorder, which includes both manic and depressive episodes.
What are the five primary mood stabilizers mentioned in the video?
-The five primary mood stabilizers discussed are lithium, valproic acid, lamotrigine, carbamazepine, and oxcarbazepine.
Why is it significant to understand the 'two poles' of bipolar disorder?
-Understanding the 'two poles'—manic and depressive—is important because it helps in determining the appropriate treatment. Patients may experience episodes of mania or depression, and the type of episode can influence the choice of medication.
How does the manic phase of bipolar disorder typically respond to treatment?
-The manic phase of bipolar disorder is commonly treated with lithium, which is considered the gold standard for patients who predominantly experience mania.
Which mood stabilizer is primarily used for the depressive phase of bipolar disorder?
-Lamotrigine is primarily used for the depressive phase of bipolar disorder.
What is the significance of knowing the different poles in answering questions related to USMLE and COMLEX exams?
-Knowing the different poles helps in reasoning through questions, especially when the test presents a patient scenario. It can guide the choice of the correct mood stabilizer based on whether the patient is in a manic or depressive episode.
What is the mechanism of action for lithium as mentioned in the video?
-Lithium modulates the phospholipinositol pathway, which is a key insight for understanding its function in mood stabilization.
Why are adverse drug reactions and cautions important to know for mood stabilizers?
-Adverse drug reactions and cautions are important because they constitute a significant portion of exam questions and are critical for patient safety in clinical practice.
How can one memorize the mechanism of lithium's action more effectively?
-The video suggests using the phrase 'phospholipinositol pathway' and associating 'lip' with the chemical symbol for lithium (Li) to make it easier to remember.
What is the clinical significance of the adverse drug reactions associated with valproic acid?
-Valproic acid can cause thrombocytopenia, elevated liver function tests, neural tube defects, and pancreatitis. Recognizing these reactions is crucial for patient monitoring and management.
How can practice questions with lab printouts and physical exam pictures help in understanding mood stabilizers?
-Practice questions with lab printouts and physical exam pictures can simulate real-life clinical scenarios, helping to apply knowledge of mood stabilizers and their adverse effects in a practical context.
Outlines
💊 Introduction to Mood Stabilizers and Bipolar Disorder
This paragraph introduces the topic of mood stabilizers, focusing on their role in treating bipolar disorder. It highlights five key drugs: lithium, valproic acid, lamotrigine, carbamazepine, and oxcarbazepine. The importance of understanding the 'two poles' of bipolar disorder—manic and depressive—is emphasized, as it influences medication choice. The paragraph also discusses how the patient's current state (manic or depressive) can affect the correct answer on medical exams like USMLE and COMLEX, providing a strategy for test-takers to deduce the appropriate medication based on the patient's condition.
📊 Bipolar Disorder Treatment Strategies and Drug Reactions
The second paragraph delves into the specifics of which mood stabilizers are used for treating the manic or depressive phases of bipolar disorder. Lithium is the gold standard for mania, while lamotrigine is preferred for depression. Valproic acid is highlighted as a treatment for mixed or rapid cycling bipolar disorder. The paragraph also underscores the importance of recognizing adverse drug reactions and cautions associated with these medications, which is crucial for exam preparation and clinical practice. It suggests using lab printouts and physical exam pictures to practice identifying drug-induced reactions, with examples given for lithium, valproic acid, lamotrigine, and carbamazepine.
⚠️ Adverse Reactions and Clinical Reasoning for Mood Stabilizers
In the final paragraph, the focus is on understanding the adverse reactions and toxicities associated with mood stabilizers, which form a significant portion of exam questions. The paragraph provides a rapid review of these reactions, such as nephrogenic diabetes insipidus and thyroid issues for lithium, thrombocytopenia for valproic acid, Stevens-Johnson syndrome for lamotrigine, and agranulocytosis for carbamazepine. It also discusses how test writers may present these adverse reactions in exam questions, using lab results or physical exam findings to challenge test-takers' clinical reasoning skills. The goal is to prepare students not only for exams but also for real-world clinical decision-making.
Mindmap
Keywords
💡Mood stabilizers
💡Bipolar disorder
💡Manic pole
💡Depressive pole
💡Valproic acid
💡Lithium
💡Lamotrigine
💡Carbamazepine
💡Oxcarbazepine
💡Adverse drug reactions
Highlights
Mood stabilizers are a group of drugs primarily used to treat different aspects of bipolar disorder.
Five key mood stabilizers to know for USMLE and COMLEX: lithium, valproic acid, lamotrigine, carbamazepine, and oxcarbazepine.
Bipolar disorder has two poles: the manic and depressive ends of the disease spectrum.
Understanding the patient's current pole in bipolar disorder is crucial for determining the correct medication choice.
Lithium is the gold standard treatment for patients primarily experiencing mania.
Lamotrigine is the preferred treatment for patients in the depressive phase of bipolar disorder.
Valproic acid is used for mixed or rapid cycling bipolar disorder where patients experience alternating mania and depression.
Carbamazepine and oxcarbazepine are used when the primary mood stabilizers do not yield a good response.
Lithium's mechanism of action involves modulation of the phosphoinositol pathway.
Adverse drug reactions are a significant focus in questions about mood stabilizers, accounting for about 75% of the content.
Lithium can cause nephrogenic diabetes insipidus, hyper and hypothyroidism, Ebstein's anomaly, and chronic kidney disease.
Valproic acid may lead to thrombocytopenia, elevated liver function tests, neural tube defects, and pancreatitis.
Lamotrigine is associated with Stevens-Johnson syndrome, a severe skin reaction.
Carbamazepine can cause agranulocytosis and is a potent inducer of the cytochrome P450 system.
Practice questions with lab printouts and physical exam pictures help to identify the drug causing adverse reactions.
Test writers often use clinical scenarios to challenge test-takers on adverse drug reactions and toxicities of mood stabilizers.
Memorizing the adverse reactions and understanding the clinical presentation can help reason through questions on test day.
Transcripts
in today's video we're going to be
talking about mood stabilizers
and we'll also touch a little bit on
bipolar disorder since the conversations
go hand in hand
now in this video we're going to talk
about mood stabilizers and primarily
when we use the word mood stabilizers
what we are referring to
is a group of drugs that treats
different aspects of bipolar disorder
and that group of drugs is shown here on
this slide
certainly this is not an all-inclusive
list there are more drugs than what you
see pictured on this
slide that in real life are actually
used to treat bipolar disorder
but as far as usmle and complex goes
and what you should be responsible to
know
you want to know these five so you've
got lithium valbroic acid
lumotrigine carbamazepine and
oxcarbazepine
before we talk about each of these drugs
individually it's important to point out
one really important fact about bipolar
disorder
that's high yield enough to help you get
some free points on test day
for those who don't know bipolar
disorder is named bipolar
because it has two poles one pole being
the manic pole or the manic end of the
disease
and the other pole being the depressive
or end of the disease
and patients can fall into either of
these two poles if you're
having an episode of depression it
doesn't mean that you have major
depressive disorder
necessarily you could just be in the
depressed
phase or at the depressed pull of
bipolar disorder
and likewise somebody who's manic is not
necessarily having a psychotic illness
if they're manic they could just be on
the
manic pole of bipolar disorder
and the reason that this is really high
yield for us emily and comlex is because
oftentimes when the test writer writes
the question
depending on which pull of the illness
they're putting a patient in
in that example that's going to affect
what the correct answer choice is going
to be
and what i'm saying is that the person
who writes this question
for us emily or complex obviously in
real life has familiarity
with bipolar disorder and in real life
depending on if the patient is manic or
if the patient is depressed so
that is to say depending on which pole
they're currently at within
bipolar disorder it affects the
medication
choice so if the question writes about a
patient who's manic
it's possible that the question is
pointing to a drug that primarily treats
mania
whereas if the question puts a patient
in the depressed poll
the test writer might be going for a
different answer
so how does that help you well this
isn't written in first aid this isn't
written in question banks but if you
know this
and this is just good clinical
information it can help you reason
through these
questions if you otherwise don't know
the information that you needed to
memorize
about the mood stabilizers so with that
in mind let's talk briefly about what
drugs treat mania
what drugs treat depression and what the
test writer might be hinting at
depending on how they paint the picture
for you in the example
so in the manic phase of the illness the
gold standard treatment is lithium for
patients
who are just manic most of their life
and don't really
experience the depressed pole you want
to treat them with
lithium now patients who are on the
depressed phase of the illness they're
better served by treatment with
lamotrigine
so i'm showing you i'm illustrating this
for you by using different lines if
you're on the top part of the graph you
spend most of your time at the manic
pole
and those patients usually get treated
with lithium first
and depressed pole patients well they're
going to be treated with lamotrigine
there is a variant where there is a
mixed or rapid
cycling bipolar disorder where the
patient actually experiences
alternating mania and depression and
those patients are better treated with
valproic
acid so these are the three main mood
stabilizers that we utilize
and then of course there's carbamazepine
and ox carbazepine
which don't necessarily fit into a manic
or depressive
pole per se but they're sort of used
when these three
aren't really getting a good response so
again
the reason that i'm telling you this is
not because you need to memorize this
for usmle or complex
but because if you care at all enough to
reason through the question
if the question is writing about
somebody and the question tells you that
this patient
spends you know 90 of their time in the
depressed phase of bipolar disorder but
has only been diagnosed with bipolar
disorder
if that's a question about mood
stabilizers i would bet my house that
they're gonna
talk about lamotrigine because that is
the drug that is primarily used for the
depressed
phase or the depressed pull of bipolar
disorder so this graph can be useful to
you clinically and i would encourage you
once you're a third year and
beyond to come back and look at this
because this will help you
not only on usmle and comlex but on your
psych rotation as well
so that's a little bit about bipolar
disorder and about which mood stabilizer
goes for which
pole which the treatment of which pole
let's go through and fill out this graph
because this is really the takeaway from
today's video
it's understanding not only the
mechanism of these mood stabilizers
but also what cautions you should be
looking out for because those cautions
and those adverse drug reactions
is going to be about probably what 75
percent of the questions on mood
stabilizers
are about so i do have a video
on anti-seizure drugs and because most
of the mood stabilizers are
anti-epileptics
i would encourage you to look at that
video if you want all of my silly
mnemonics for
memorizing the mechanisms of all of
these different drugs
the exception obviously being lithium
which doesn't treat seizures at all
so i'm going to just fill in this chart
and i'm not going to talk about the
mechanisms at
all again if you want mnemonics for the
mechanisms
check out the anti-epileptic video
because i've already gone through all of
that before
what's incredibly important for you to
take away from this video
are two things one one mechanism i will
talk about is the lithium's
mechanism so lithium if you you know if
you look in first aid
i'm gonna bet that it says mechanism
unknown and that's technically not true
we do
we do know how lithium works it
modulates the phosphoenocetal pathway
it does a lot of other things as well
but this is what could start to show up
on usmle on complex on your shelf exams
we're learning more and more about this
as as continuous research comes out
so in order to memorize that instead of
saying phospho-inositol
pathway i think you should say
phospholipin-acetal pathway because the
lip
is the chemical symbol for lithium the
li
so lithium lithium modulates
phospholipinositol
and that's just a stupid easy way to
memorize that
again the important takeaway from this
slide is all of the adverse drug
reactions all of the cautions
for lithium it's a ton of stuff right
you've got nephrogenic diabetes
insipidus
hyper and hypothyroidism ebstein's
anomaly chronic kidney disease
for valproic acid you have
thrombocytopenia
elevation of your lfts neural tube
defects and pancreatitis
for lamotrigine you've got the famous
stevens johnson syndrome
for carbamazepine you'll see a
granulocytosis you could see s-i-a-d-h
and this is an extremely extremely
potent
p450 inducer now
instead of just going through this i
think the best way to approach this is
to give you practice questions with lab
printouts and
physical exam pictures and ask you
what is the drug that they're talking
about so the way that this will work on
test day is you'll get a question
that'll look something like this it'll
tell you that a male
has a med has a medical history of an
unknown mood disorder maybe they'll say
bipolar maybe they won't
they'll tell you that he's got some
medical problem right they're going to
be vague about it they're going to be
like good headache gi upset whatever
it's going to be non-specific
but what's really specific is they'll
say on review of his labs
you note the following and they'll give
you that little lab printout
and that'll have a little area where you
can check the normal values so don't
worry if you don't know what's normal
for all of these but we'll go through
this and assume that you do
and then it'll ask you which of the
following medications is responsible
for this adverse drug reaction or which
of the following medications was this
patient prescribed
and what the question is basically
asking you is
what mood stabilizer is causing the
problem
that i've written about in this question
that's what the test writer is going for
and your choices will be lithium vaporic
acid lamotrigine carbamazepine or ox
carbazipine
or maybe they'll be really annoying and
they'll throw in other distractors like
you know ssris etc etc so
let's start with this example so you've
got this printout and obviously there's
some problem
with one of these labs and if you've
been doing enough practice questions you
can probably look at this and i
already identify what the problem is the
problem is that the white cell count is
low and therefore the answer here is
carbamazepine because what the test
writer might be going for
is agranulocytosis or neutropenia so
in this one that is the drug that's
responsible for the reaction so we're
going to go through this rather quickly
this is sort of rapid review
what about this one i didn't change the
vignette at all i did was change the
labs around
so which of the following medications is
responsible for this
adverse drug reaction you can pause the
video if you want to think about this
but the
answer is going to be lithium so you see
that the creatinine
is elevated and lithium does cause
nephropathy
it causes a chronic interstitial
nephritis
it causes nephrogenic diabetes insipidus
and in all of those cases you could see
a bump in your creatinine
so the fact that we're seeing an
elevation of creatinine on this lab
printout
shows you that lithium is the drug
responsible because none of these other
medications are really going to do that
what about this example
pause the video if you'd like some more
time to think about it
but if you've been doing enough practice
questions you'll probably recognize that
in this example
platelets are low and the only
medication that causes
thrombocytopenia profoundly
on this list is going to be valprolic
acid so b
valpric acid now in this question
i left the the vignette pretty much the
same and i changed one sentence
i wrote on physical exam you know the
following and then there's a picture
and the question is now which of the
following medications is responsible for
this adverse stroke reaction and what
you're seeing
here if you're even if you're not sure
that this is stevens-johnson syndrome
you should assume that it is given the
five answer choices because no drug
besides lamotrigine
causes stevens-johnson syndrome or a
malignant appearing rash on the mucosal
surfaces
so you can safely assume because we're
talking about mood stabilizers that this
is probably
sjs or stevens-johnson syndrome
and therefore the answer is lamotrigine
now let's do this practice question so
we're going back now to the review of
labs
and on this lab pronoun we're looking at
liver function tests or lfts and we're
looking at pancreatic enzymes
and the question now is which of the
following medications or
mood stabilizers is responsible for this
adverse drug reaction
so obviously because lipase and amylase
are both
normal you can assume if you're not
already comfortable enough to recognize
the actual values themselves you can
assume that these lfts are elevated and
the only mood stabilizer
that's going to classically cause what
we refer to as a transaminitis where
that is to say that the lfts are
elevated
the only mood stabilizer that will do
that is valproic
acid let's move on to another example so
i know guys rapid review but i'm trying
to get your brain to process this so
that you get the point on test day
um same thing and now our lfts are
normal
but our pancreatic enzymes are high
and again the only mood stabilizer that
is known to cause pancreatitis
is b valproic acid so i know i went
through that really really quickly
i understand that you may need to watch
this a few times to really get those
adverse drug reactions down
but this is really going to be the bulk
of your questions when you sit
on test day again adverse drug reactions
toxicities that is what the test writers
love to go after because these drugs
these mood stabilizers for the most part
all have such a narrow
therapeutic index so what should you
take away from this video well
obviously the mechanism of lithium the
phospholipinositol pathway
and then all of the adverse drug
reactions that we talked about
think about the different ways that test
writers could present them to you on
test day and how they could tie these
into different questions
if they want to talk about epstein's
anomaly with lithium they'll talk about
reproductive and embryo
and embry um embryology if they want to
talk about stevens-johnson syndrome with
lemichtel they'll show you a picture
right they could just show you a picture
of someone's lips or someone's eyes
if they want to go for a granulocytosis
with carbamazepine
they could show you the lab print out
and give you the low white count or
they could talk about an opportunistic
infection and link it to hiv
in some way and then ask you about
treatment or ask you about what other
disease process might you see this
in so there's a lot of different ways to
connect all this material
and it all becomes really high yield
because the test writer wants to
challenge you
to think clinically and to think and
reason through the information
that you need to know so yes mood
stabilizers are high yield yes mood
stabilizers are important but if you
if you know the up and down side chart
that i showed you
at the beginning of this video you can
actually reason through a lot through
all of this
a lot faster
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