Anticonvulsants Used as Mood Stabilizers

Anticonvulsants Used as Mood Stabilizers

• Stevens-Johnson Syndrome - Assess for skin rash, hold medication and contact prescriber immediately.
• Hepatotoxicity - Liver function tests at baseline and periodically. Teach importance of keeping appointments for tests.
• Teratogenic - Childbearing age women should have a pregnancy test at baseline and periodically. Inform them about the risk and advise them to use birth control.
• Drug Toxicity - Serum drug levels may be monitored, teach importance of keeping appointments for tests.
• Blood Dyscrasias - Monitor Complete Blood Count (CBC) at baseline and periodically. CBC includes:
  • White blood cell count (WBC) - Assess for symptoms of infection, normal range is 4,000 to 11,000.
  • Red blood cell count (RBC) - Assess for symptoms of anemia and low oxygenation, normal range is 4.5 to 5.7.
  • Platelet count - Assess for signs and symptoms of bleeding, normal range is 150,000 to 400,000.

Client Education

• Monitor for symptoms of blood dyscrasias - Hold the medication and contact the prescriber if you experience symptoms.
• Important food and drug interactions - Avoid other medications or products that boost serotonin. Avoid alcohol, grapefruit products, and caffeine.
• Not a cure - Anticonvulsants are not a cure for mood disorders.
• Abruptly stopping medication - Do not stop taking the medication abruptly. Work with your prescriber to taper off the medication to avoid discontinuation syndrome.
• Childbearing age women - Plan healthy pregnancies with your doctor after your clinical condition is stable.

Tricyclic Antidepressants

• Mechanism of Action - Block the re-uptake of norepinephrine and some serotonin.
• Use - Used for moderate to severe depression, not for suicidal clients.
• Symptom Relief - Elevate mood, reduce negative thoughts, improve concentration, promote feeling of well-being, increase appetite, stimulate interest in activities of daily living, reduce preoccupation with somatic complaints, and promote healthy sleep-wake cycles.
• Time to Take Effect - Takes weeks to see relief from depression symptoms, months for full effect.

MAOI Antidepressants (Monoamine Oxidase Inhibitors)

• Mechanism of Action - Inhibit monoamine oxidase (MAO). This prevents MAO from breaking down norepinephrine, serotonin, and dopamine, making these neurotransmitters more readily available.
• Tyramine Interaction - MAO also metabolizes tyramine. When MAO is inhibited, tyramine builds up and can cause a hypertensive crisis. Tyramine is found in aged, processed, preserved, pickled, smoked, fermented, and cured foods.
• Use - Used for moderate to severe depression.
• Symptom Relief - Similar to tricyclic antidepressants, including:
  • Elevate mood
  • Reduce negative thoughts
  • Increase appetite
  • Promote feeling of well-being
  • Improve concentration
  • Stimulate interest in activities of daily living
  • Reduce preoccupation with somatic complaints
  • Promote healthy sleep-wake cycles

MAOI Client Education

• Monitor blood pressure - Monitor your blood pressure and contact your prescriber if it increases.
• Hypertensive crisis - A hypertensive crisis is a potential fatal reaction. Hold the next dose of medication and seek immediate medical attention, including a doctor, urgent care, or the emergency department.
• Tyramine - Learn what tyramine is, how to avoid it, and why it is important to avoid tyramine.
• Serotonin syndrome - Do not take other serotonin-boosting agents, such as other antidepressants.
• Serotonin syndrome symptoms - Hold next dose and seek immediate medical attention if you experience these:
  • Agitation
  • Diaphoresis
  • Increased body temperature
  • Increased heart rate
  • Decreased blood pressure
  • Muscle rigidity
  • Hyperreflexia
• Wash-out period - There is a 5-week wash-out period to avoid the risk of serotonin syndrome if you switch from another MAOI to another medication.

Antipsychotics

• Metabolic Syndrome - Monitor for metabolic syndrome (prediabetes and cardiovascular disease). This includes monitoring:
  • Lipid panel - Cholesterol, HDL, LDL, and triglycerides
  • Blood sugar - Blood glucose and Haemoglobin A1c
  • Body mass index (BMI)
  • Waist circumference
• Client education for metabolic syndrome - Focus on lifestyle changes to manage this, including:
  • Nutrition - Low fat, low carbohydrate, high fiber diet
  • Exercise - Daily exercise
  • Weight management - Watch your weight

Antipsychotic Side Effects and Client Education

Extrapyramidal Symptoms

• Symptoms - Dystonia, akathisia, and pseudoparkinsonism.
• Treatment - Contact prescriber and they may add medication to address these symptoms, such as benztropine for pseudoparkinsonism or propranolol for akathisia.

Anticholinergic Side Effects

• Symptoms - Dry eyes/blurred vision, dry mouth, urinary retention, constipation, orthostatic hypotension, and sexual dysfunction.
• Treatment - Self-monitor symptoms and contact prescriber for potential dose changes.

Increased Prolactin Levels

• Symptoms - Gynecomastia, lactation, and discomfort.
• Treatment - Self-monitor and report to prescriber to monitor prolactin levels.

Client Education for Antipsychotics

• Photosensitivity - Avoid prolonged exposure to sunlight.
• Seizure threshold - Antipsychotics can lower the seizure threshold.
• Abruptly stopping medication - Do not stop taking the medication abruptly. Work with your prescriber to taper off the medication to avoid discontinuation syndrome.
• Long-acting injectable forms available - Some antipsychotics are available in long-acting injectable forms which can improve compliance.
• Not a cure - Antipsychotics are not a cure for mental illness.
• Important food and drug interactions- Avoid alcohol and grapefruit products. Check with your prescriber or pharmacist before taking any other medications or over-the-counter remedies.
• Other laboratory tests - Liver function tests are often monitored and renal function may be monitored as needed.

This quiz covers key considerations when using anticonvulsants as mood stabilizers. Topics include monitoring for Stevens-Johnson Syndrome, hepatotoxicity, teratogenic effects, drug toxicity, and blood dyscrasias. Understanding these factors is crucial for safe medication management in psychiatric settings.