Stabilizes mood:

Prevent relapse

Mood Stabilizer

Abolish :
Excitement
Euphoria (state o optimism, cheerfullns & well being)
Insomnia

Drp lbnu 'Umar r.a. bahawa Rasulullah SAW telah bersabda: "Aku telah
diperintahkan supaya memerangi manusia sehingga mereka naik saksi bahawa
sesungguhnya tiada Tuhan melainkan Allah dan bahawa sesungguhnya
Muhammad utusan Allah, sehingga mereka mendirikan sembahyang dan membayar
zakat. Apabila mereka telah berbuat demikian, maka mereka telah memelihara darah
mereka dan harta mereka daripada aku, melainkan dengan hak lslam, dan hisab
perhitungan amal mereka terserah kepada Allah Ta'ala.

Lithium
Well absorbed orally
X metabolized , x protein bound
Cross BBB
T = 20-24hr
therapeutic index : monitor [Li+]
Effect : several d & 2-4 wks to fully dvlp

Sodium valproate (epilim)

Oral/IV
Broad therapeutic index
Rapidly & completely absorbed following oral admin
T = 8-17hr
Mets : liver

Indication

Prevent relapse of affective disorder

(prophylaxis)
Mania , bipolar
Stabilze mood control mania symtoms
Acute manic
Resistan depression augment effect o anT
depressant
Schizoaffective or cyclothymia

MOA

Specific mechanism : unknown

Li+ replaces Na+ equally distributed affect
ion flux across brain cell & modify cellular
mbrane property
Li+ x NA & DA in CNS
Li+ x enzyme involve in recycling o mbrane
phosphoinositide 2nd messenger
adrenergic & muscarinic transmission

Absence seizure w concomitant generalized tonic

clonic seizure
Myoclonic seizure
Atonic seizure
Partial seizure
Bipolar disorder
Migraine
Acute mania in child & elderly
Schizoaffective d/o
Block high frequency repetitive firing o neurons
Block Na+ currents
BlocK NMDA R mediated excitation

PK

nha 0813

Carbamazepine
Oral complete absorp
Induce hepatic microsomal enzyme inhibit
owns mets
Monotherapy or combine wif Li+
T = 18-55hrs
Mets : liver
Safe in pregnancy
Generalized tonic clonic
Complex partial seizure
Trigeminal neuralgia
Bipolar dz
Acute mania
Prophylactic therapy

Bind + prolong inact state o Na+ channel

block o sustained frequency repetitive firing
o AP
Alter Na+ K+ Ca2+ conductance membrane
potential [amino acid] [NA] [A] [Ach] [GABA]
[ ] - release o serotonin/NA promotes uptake
o dopamine inhibit MAO actvt
Interact w membrane lipid stabilize mmbrane
Block Na+ channel
Inhibit repetitive firing in neurons
Acts presynapticly synaptic transmission

Drug intrxn

s/e

C/I

nha 0813

Li+ clearance Li+ toxicity

Thiazide diuretics
ACEi
Tetracyclines
NSAID (xcept aspirin + acetaminophen)
All anTpsychotic drug (xcept clozapine & newer
drug) xtrapyramidal sx
CNS
Tremor, ataxia, choreoathetosis
Slurred speech/aphasia
Mental confusion, forgetfullns, drowsins
Motor hyperactvt
Thyroid dysfx
Goiter (interfere tyrosine iodination but norm px
euthyroid)
Hypothyroidism
Kidney
Nephrogenic diabetes insipidus
Minimal glomerulopathy
Chronic interstitial nephritis
Electrolyte
+
Initial Na & H2O loss Na+ & H2O retention
edema (d/t aldosterone secretion)
CVS
Benign & reversible inversion T wave
Others
GIT : N+V+D / Wt gain / Rash
Sick sinus syndrome px
Pregnancy
Fetal congenital abnorm: cardiac Ebsteins anomaly
Fetal goiter, hypotonia
B-feed
Secreted in milk Baby lethargic, cyanose,
abnorm Moro reflex
Renal failure/ cardiac failure or recent MI

Inhibit own mets

hep mets o other drug primidone,
phenytoin, ethosuximide, valproate, clonazepam
Inhibit mets o :
Phenobarbital,
phenytoin,
carbamazipine, Phenytoin, Phenobarbital induce hep enzyme
carbamazepine mets
ethosuximide
Propoxyphene,
valproate

inhibit
Displace phenytoin from plasma prot
carbamazipine clearance
N,V, abd pain, heartburn
Sedation ++ (used w phenytoin)
Thrombocytopenia
Hepatotoxicity
Idiosyncratic rxn
Severe fatal
Px < 2y/o
Congenital abnor caution in preg

Pregnancy

Diplopia
Ataxia
GIT upset
Unsteadiness
dose drowsiness
hypoNatrinaemia
water intoxication
blood dyscrasias : aplastic
agranulocytosis
erythematous skin rash ; SJS (rare)

anaemia,