Stabilizes mood:

Prevent relapse PK

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

Mood Stabilizer

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 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 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

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

Indication

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

MOA

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

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Drug intrxn

s/e

C/I

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 + & H2O loss Na+ & H2O retention Initial Na 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 Diplopia Ataxia GIT upset Unsteadiness dose drowsiness hypoNatrinaemia water intoxication blood dyscrasias : aplastic agranulocytosis erythematous skin rash ; SJS (rare)

anaemia,

Pregnancy

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