Mood Stabilizer Drugs PDF

# Mood Stabilizer Drugs ## Team * Senior2025 * Faculty of Nursing * MU 28 TH * Psychiatric # Mood Stabilizing Drugs ## Lithium carbonate * It is the drug of choice for treating the manic phase of bipolar disorder * It is a mood stabilizer and is often referred to as anti-manic drugs * Generic n...

# Mood Stabilizer Drugs ## Team * Senior2025 * Faculty of Nursing * MU 28 TH * Psychiatric # Mood Stabilizing Drugs ## Lithium carbonate * It is the drug of choice for treating the manic phase of bipolar disorder * It is a mood stabilizer and is often referred to as anti-manic drugs * Generic name: Lithium carbonate * Trade name: Lithium, perianil, Eskalith, lithonate, lithobid # Administration * **Route of administration and doses:** * Initially 300-600 mg by mouth is given 3 times per day to reach therapeutic lithium level of 0.7 to 1.2 or 1.5 mEq/L * **Lithium Serum Level:** range from 0.7-1.2 mEq/dl (300-2700 mg). * **Note:** Lithium has a narrow therapeutic range. Very narrow range form the therapeutic dose to toxicity through switching from 0.7-1.5 (from one tablet to two tablets) * **Toxicity:** often occurred at serum level higher than 1.5 mEq/L, so blood level should be monitored * Blood should be taken 8-12 hours after the last dose of lithium * Blood levels have been monitored weekly or biweekly until the therapeutic level is reached * After the therapeutic level has been reached, blood level must be measured every month. After 6 months (6 months to a year) of stability, blood level should be taken every 3 months ## Action 1. **Prophylactic action:** on manic depressive phase, prevent recurrent which is common in these disorders 2. **Therapeutic action:** on manic phase ## Mechanism of Action * The therapeutic mechanism of action for lithium remains uncertain. * In the body, lithium substitutes for sodium, calcium, potassium and magnesium due to its similarity to these ions. * This may relate to its therapeutic effect * It normalize or stabilize neurotransmitters activity in the brain. More specifically, it normalizes synaptic transmission of NE, serotonin and dopamine. * Lithium also inhibits the release of thyroid hormone and testosterone. * Mood stabilizers increase GABA activity and seem to have an antimanic and antianxiety effect. ## Therapeutic Indication * **Bipolar I disorder:** Manic episodes, Depressive episode * **Schizophrenia:** The symptoms of one-fifth to one-half of all patients with schizophrenia are further reduced with lithium administration and antipsychotic reduce remittent aggressive outbursts of Schizophrenia * **Reinforcing agent:** Used to reinforce the effect of another drug. * **Schizoaffective disorder** * **Aggressions in mates, children → conduct disorder & mentally retarded patient** * **Episodic disorder characterizing premenstrual dysphoric disorder (PDD)** * Bulimia nervosa & episodes of binge drinking * **Treating impulsive behavior** ## Lithium Carbonate ### Adverse Effects * **Neurological:** Dysphoria, occasional extra pyramidal tremors, ataxia, dysarthria, neuromuscular irritability, severe epileptogenic * **Endocrine:** Goiter, hypothyroidism, hyperthyroidism, para thyroidism, hyper para thyroidism, adenoma * **Cardiovascular:** Benign T wave changes, Sinus node dysfunction * **GIT:** Appetite loss, nausea, vomiting and diarrhea * **Renal:** Concentrating defect, morphological changes, polyuria, nephrotic syndrome, renal * **Musculoskeletal:** Peripheral neuropathy, lowered seizures' threshold as (fit during sleeping results in incontinence) * **Dermatological:** Acne, hair loss, psoriasis, rash * **Miscellaneous:** Altered carbohydrates metabolism, weight gain and fluid retention ### Contraindication * Brain disease * Thyroid disease * Severe cardiac disease * Dehydration * Renal disease * Pregnancy and lactation # Nursing Care * Baseline work up for the client beginning lithium (Investigations) * Medical and psychiatric history * Physical examinations, include * EEG: because lithium affects the brain * Thyroid function test (free T3, T4 and the most relevant and important is thyroid stimulation hormone (TSH), it shows if the thyroid function is suppressed) because lithium inhibits the release of thyroid hormone. TSH & S. creatinine should be measured every 6 months in patients on long-term therapy * ECG: to detect any cardiac problems because lithium affects the heart * **Note:** Blood pressure → Hypertension. If the patient takes diuretics it increases the occurrence of toxicity. * **Kidney function test:** especially serum creatinine because lithium affects the renal concentration. * **Complete blood count** * **Blood sample:** should be taken 10-12 hours from the last dose of lithium * **Lithium blood serum level:** should be taken weekly for the first two months and after that each month. # S&S of Lithium Toxicity 1. **Mild - Moderate Toxicity (1.5 - 2.0 mEq/dl):** Tremors, vomiting, nausea, diarrhea, dry mouth, abdominal pain, muscle weakness, dizziness, slurred speech, ataxia, lethargy or excitement 2. **Moderate - Severe Toxicity (2.0 - 2.5 mEq/dl):** Severe diarrhea, increased muscle weakness, blurred vision, diluted urine, drowsiness, impaired consciousness, stupor, coma, cardiac insufficiency, delirium, syncope, convulsion 3. **Severe Toxicity (More than 3 mEq/dl):** Generalized convulsion, oliguria, renal failure, death # Toxicity and Overdose * There is a fine line between therapeutic levels and toxic levels of lithium * **Cause of Lithium Toxicity** * Decreased renal function * Decreased sodium intake * Use of diuretic therapy * Increased fluid and electrolyte loss: sweating, diarrhea, dehydration, fever and vomiting * Overdose of lithium # Management of Lithium Toxicity 1. Discontinue the drug 2. ICU 3. Maintain airway clearance - endotracheal tube 4. There is no specific antidote so initiate supportive measures 5. Gastric decontamination 6. Gastric lavage within one hour from ingestion 7. Administer IV fluids (sodium chloride) acts as washing and to correct fluid and electrolyte imbalance 8. Hemodialysis in case of severe toxicity (more than 3 mEq/dl) to protect the kidney functions 9. Monitor vital signs 10. Monitor cardiac function # Patient/Family Teaching * **Nurse rules and patient teaching about lithium:** * Instruct the client to take the prescribed dose on a regular basis as ordered by the physician * Instruct the client to take the prescribed dose during or after meals to decrease gastric irritation * Instruct the client not to drive or use dangerous machines until lithium levels stabilize as the drug causes drowsiness and dizziness * Instruct the client to avoid intake of beverages containing caffeine (tea, coffee and colas) as it increases urine output and increases the possibility of toxicity * Monitor serum lithium levels at least twice a week during the initiation of therapy then every month * Instruct the client to increase fluid intake to prevent dehydration * Instruct the client to take the adequate amount of sodium in their diets (not increasing or decreasing sodium intake) * Avoid excessive exercise in warm weather. Excessive perspiration increases the risk of adverse effects * Notify the physician if signs and symptoms of toxicity occur (tremors, nausea, vomiting, diarrhea, blurred vision, ataxia, confusion) * Be aware of being pregnant while on lithium therapy * Diet should be adequate while decreasing calories to manage weight gain problems # Anticonvulsants drugs * Anticonvulsants may be used to treat clinical symptoms of bipolar disorder, agitation, and aggressive behavior * **Mechanism of action:** * Unknown, there has been focus on the ability to inhibit kindling (increasing behavioral and convulsive responses occurring in reaction to the repetition of the same stimulus over time) ## Classifications | Generic Name | Trade Name | |---|---| | Carbamazepine | Tegertol | | Clonazepam | Klonopin | | Gabapentin | Neurontine | | Valproic acid | Depakene | | Valporate | Depakote | ## Indications * Alternative to lithium for the treatment and prophylaxis of mania. * Control seizures activity (grand mal) or seizures associated with neurosurgery. * Treatment of individuals experiencing substance abuse withdrawal. * Treatment of delirium and dementia ## Side effects: * Dizziness, blurred vision, sedation, GI upset. * Tremor, slurred speech, nausea, vomiting. * Ataxia, central nervous system depression. ## Contraindication * Client with CNS depression * Liver & renal disease * Bone marrow depression * Pregnancy and lactation # Nursing implications * Give drug on a regular schedule to maintain therapeutic blood level. * Administer oral anticonvulsant drugs with meals or fluid to reduce gastric irritation. * Observe for therapeutic effects that occur 7-10 days after drug therapy is initiated. * Monitor for adverse effects. * Arrange for laboratory testing to monitor client liver function. * Avoid the use of antacids because they reduce the serum level of anticonvulsant. # Quote * "**تعدل ثلث القرآن .**" * "**قل هو الله أحد • الله الصمد لم يلد ولم يولد .**" * "**ولم يكن له كفوا أحد .**"