mood stabliuzer

mood stablizer can treat order

-anxiety

-OCD

_pTSD

-eating disorder

-chronic pain

-personality

-dependence

reduce mood stablizer ss

-skeep /appetite/sex drive/faitgue disturbance

-psychomotor retardation/agitation

‘change variation in mood

impaird concentration

anhedonia

how long does mood stablizer to help

1-3wk except TCA take longer

serotonin selective reuptake inhbitor indication

well tolerated, cause fewer side effect

block serotonin reuptake

improve sleep,appetie, more intetrest

side effect Ssri

H/A.agitation,inspmnia,sexual dysfunction,nausea, fatigue

SSRI warninh

discontinuation syndorme：dizzy, insomnia,nervousness,irritability, nasuealagitation

contraindicate if takr MAOI

SSRI example

celexa

proxetine

fluxetine

setraline

serotonin noepinephrinere reuptake inhbitor indication

bock reuptake of seotonin, and nonepinepherine

result inpostive feeling of well being and better modd from serotonin ,more alertness and energy from epinerphine

SNRI side efffct

hypertension(effecor)

dry mouth

headache

agitation

nausea

insomnia

seuxal dysunction

SNRI ex

effxor after SSRI not working need to monitor BP espically if high dose and HTN history

duloxetine advantgae of decreaee neuropathic pain

tricylic antidepressant ex

amitriptuline elvil

clomipramine-anafranil

notriptyline0aventyl

4-8wk

TCA MOA

incrase serotonin and NE availability

blocj adrenergic ,histamine, Ach receptor

TCA SE

ortho hypotension

sedation

drymouth

unrnary retention

constipation

worsen cardia condition

tachycardia

interaction TCA

CARDIA DISORDER, ELEVATED INTRAOCULAR PRESSUE

URINARY REtention

hyperthroidism

seizure

liver /kidney dysunction

T CA benfical for 2 reasons

habe sedative effect

aid sleep

minor se only while sleep,increase adherence

MAOI use

highly effective not 1st line, because diet limitation

break down NE,serotonin, dopamine, tyramine

resiu;t in modd elvation

increase tyramine result in hypertensive crisis

avoid tyrmaine food MAOID

fermented meat

cheese, redwine

bring hypertensive crisis, possible stoke, intracrnial hemorrrhage, hyperpyrexia, convulsion,coma

MAOID side effect

-prtho hypitension

-weight gain, edema

0increase rate and rhythm heart

-consitpation

-sexual dysfunction

-hypomanic,manic behabior

-insomnia, weakness, fatigue

-agitation,nasuea,dizz

nE use

alertness, concentration,energy

Ach use

learning,memeory,behabior

sertonin use

sleep reglation,appeite,libido,mood

dopaine use

emotion,decision maing,movement,

histamine use

alrteness and inflammrot response

serotonin syndrom ss

-fever, swaeintg, tachy,hypo,diarrhea, lated mental status.abnormal muscle activity

severe:high fever, carid shock ,death

serotonin syndrome tx

if withdrawl

anticonvulsant can decrease agitation,seizure like,muscle stifffness

dantrolence/diazepla for rigidity

lithium use

allevite mania symptom ,maintenance BPD tx

take 7-14d to reach therapeutic level

lithium dose

-acute manic 600-1300mg in 2/3 dose

the increase 300mg .day with max1800mg

atypical antipsychotic and benzo can decrease psychomotor

therpetutoic index lithium

thereptutic blood level 0.5-`.3

checi blood weekly until reach theapwutic lvel

thewn check qm for 6m

after 13m

need to do in am 10-12hr after forst blood

;ithium use for

-elation

-grandiosity

-anxiety

-irritability

-flight of oidea

reduce less in

-insomnia

-psychomotor agitation

-assulativative behavior

-distractibilitu

-hypersexialotu

-paranoia

MOA lithiu,

affect Na and K to reuce overexicitement in neuron

increase serptpmom ,inhbit dopamine sysnthesis, decrease gluctamate, enhance GABA

SE lithium

-mild thirst

-mild nasea

-polyuria

-weight gain

-hand trremor

early sign of lithium toxocity

-nausea

-diarhea

-thirst

=polyuria

-sluured sppech

-lethargy

-muscle weakness

-fine hand termor

-muscle weakness

interventio. of sespected toxicity

hold lithium

need do drawn blood level

address dehydration

advanced sign of toxicity

1.5-2

confusion persistent GI upset

muscle hyperiiratblity

corase hand tremor

incooridnation

severev tosicity

>2

blurred vision

large diulte urine

seizure

hypotension

coma

lithium conterindication

-cardio

renal

throid

MS

dehydration

brain damage

anticonvulsant ex

carbatemzepine

valopric acid

epival

lamictal

anticconvulsant prescribe to pt

not repsond to lithium

not tolreate lithium

contrdicate lithium

loithium cause thrpid and kidney damage

moa lithiuk

establish balance between exict and inhbit stablize mood

inhbit sodium,calicum,GABA

tegretol side effect

hypotension

dizziness

chonlinergic

monitor liver unction CBC

epival and valopric acid se

-drowziness

-dizziness

-weight gain

monitor liver and platelet function, risk of thrombocyptopenia

lamitcal se

drowziness

cause weiht gain

cuse steven johnson

antianxiety for acute mania

offer quick relief from disturbing and agnoizing

effective in calm, agiation ,reduce anxiety

rivotril.aivan

atpical antipsychotic for acute mania

zyprexa

risperdal

sedative and mood stabilizing

why not combine zypresa and tegretol

affect helatic metabolism’decrease effectiveness

1st line o[tion whe combine required

lithium/epival

+SSRI,wellbutrein

2.zyprexa and SSRI

health teaching for mood stablizer

-determine non adherence reason

-monitor se

=explain effect take few wks

-close monitor suicidal thpought

-not dc aburptly

lithium and sodium

-lithium decrease na reabsoption cause na deficenty,lead to lithium retention and tpxcity

-monitor salt in diet and na level

-1.5-3L

-take with meal, cause polyuria

-weight gain, infrom md

-tape down lithium

-if have ss od dehydration need to inform

-check thrpid and renal function

-lead to hypothroidsm, imparie kindey ability

-not diruetic, ,ACERI,NSAID