Mood Stabilizing Drugs-Daga, Ja
Mood Stabilizing Drugs-Daga, Ja
Mood Stabilizing Drugs-Daga, Ja
MOOD STABILIZING DRUGS Used to treat bipolar disorder by stabilizing the clients mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania. Commonly given to manic patients Lithium is considered a first-line agent in the treatment of bipolar disorders. Lag period: 7-10 to 14 days
INDICATION
Indication to: Acute mania Bipolar prophylaxis Possibly Bulimia Alcohol abuse Aggressive behavior schizoaffective
MECHANISM OF ACTION
Mechanism of action in bipolar illness is poorly understood. Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine, and dopamine. It also reduces the release of norepinephrine through competition with calcium. For anticonvulsants the mechanism of action is not clear as it related to their off-label use as mood stabilizers.
MECHANISM OF ACTION Normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine and dopamine Effects intracellularly
MECHANISM OF ACTION Valproic acid and topiramate are known to increase levels of the inhibitory neurotransmitter GABA. Both valproic acid and carbamazepine are thought to stabilize mood by inhibiting the kindling process. This can be described as the snowball-like effect seen when minor seizure activity seems to build up into more frequent and severe seizures.
CONTRAINDICATION Brain damage/ CV disease Epilepsy Elderly/ debilitated Thyroid and renal disease Severe dehydration Pregnancy (1st trimester)
EXAMPLES Valproic acid (Depakene) divalproex sodium (Depakote) sodium valproate (Depacon, Epilim) Lamotrigine (Lamictal) Carbamazepine (Tegretol) Oxcarbazepine (Trileptal) Valproate (Depakene syrup)
SIDE EFFECTS
Lithium carbonate Early Nausea and diarrhea Anorexia Fine hand tremor (propranolol) Thirst, Polydipsia (dec. crea, inc. albumin) Metallic taste Fatigue Lethargy Late Weight gain acne
SIDE EFFECTS
Carbamazepine (Tegretol)
SIDE EFFECTS
Valproic acid (Depakote, Depakene)
NURSING RESPONSIBILITIES
For Lithium carbonate: o Lithium levels should be checked q 2-3 mos o Serum drawn in the AM, 12H after last dose o Common causes of inc. levels
Dec. Na intake Diuretic therapy Dec. renal functioning F&E loss Medical illness Overdose NSAIDS
NURSING RESPONSIBILITIES
o Diet: adequate Na+ and fluid
o 3g NaCl/ day o 6-8 glasses of H2O
NURSING RESPONSIBILITIES
Always remember the therapeutic level of Lithium to prevent lithium toxicity. Therapeutic serum level: 0.5 1.2 meq/L Maintenance level: 0.6 -1.2 meq/L
NURSING RESPONSIBILITIES
High doses of Lithium can cause lithium toxicity. Toxic
Mild to moderate: 1.5 to 2 meq/L Moderate to severe: 2 2.5 meq/L Needs dialysis: 3 meq and above
NURSING RESPONSIBILITIES
If lithium toxicity occurs:
o Severe toxicity
NURSING RESPONSIBILITIES
For Carbamazepine (Tegretol): Assess drug levels q 3-4 days Monitor salt and fluid intake Avoid alcohol and non-prescription drugs Refer dec. in UO Dont stop abruptly C/I: pregnancy Take with meals
NURSING RESPONSIBILITIES
For Valproic acid (Depakote, Depakene):
o Therapeutic level: 50 100 ug/mL o Dose: 1, 000 1,500 mg/day o Monitor serum levels 12H after last dose Toxic effects
Severe diarrhea, vomiting, drowsiness, mm. weakness, lack of coordination Renal failure, coma, death