MOOD STABILIZING DRUGS

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 Lithium carbonate

Trade names Eskalith Lithotabs Lithane Lithonate

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)

Dizziness Ataxia Clumsiness Sedation Dysarthria Diplopia Nausea & GI upset

SIDE EFFECTS
Valproic acid (Depakote, Depakene)

Nausea Hepatoxicity Neurotoxicity Hematological toxicity Pancreatitis

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

o No caffeine o No driving: wait for clinical effect

TO PREVENT LITHIUM TOXICITY DO THE FF FIRST: Urinalysis (BUN and creatinine) ECG, FBC, CBC

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

Early signs of toxicity

Lethargy, mild nausea, vomiting, fine hand tremors, anorexia, polyuria, polydipsia, metallic taste, fatigue

Late signs of toxicity

Ataxia, giddiness, tinnitus, blurred vision, polyuria

NURSING RESPONSIBILITIES
If lithium toxicity occurs:

o Moderately severe toxicity

Osmotic diuresis: urea/ mannitol Aminophylline & PLR IV Adequate NaCl Peritoneal/ hemodialysis Assess hx quickly Hold next lithium dose Check BP, rectal T, RR, LOC, support O2 Obtain labs ECG Emetic, NGT lavage Hydrate: 5-6L/day c PLR;

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