NUR 2011 Psych: Mood Stabilizers

What are mood stabilizers?

Relieve symptoms during manic and depressive episodes, prevent recurrence of manic and depressive episodes, do not worsen symptoms of mania or depression or accelerate rate of cycling

What are antipsychotics used for?

Given during severe manic episodes

Examples of mood stabilizing drugs?

Lithium, antiepileptic/anticonvulsants, antipsychotics

What is Lithium?

Simple inorganic ion, naturally found in animal tissues

What are the therapeutic uses of lithium?

Bipolar disorder mostly, alcoholism, bulimia, schizophrenia, glucocorticoid-induced psychosis

What is the mechanism of action for lithium?

Altered distribution of certain ions, altered synthesis and release of norepinephrine, serotonin, dopamine. Mediate intracellular responses to neurotransmitters, can increase gray matter in regions known to atrophy in BPD

When is the onset for Lithium?

5-7 days, up to 2 weeks

Lithium is excreted by the ___.

Kidneys (monitor BUN and creatinine)

What electrolyte needs to be monitored when someone is on Lithium?

Sodium (lithium excretion reduced when sodium levels are low)

What is the therapeutic range for Lithium?

0.8-1.4 mEq/L in mania, 0.4-1.3 mEq/L maintenance

What are side effects of Lithium?

Nausea, mild diarrhea, mild abdominal pain, mild bloating, metallic taste, increased thirst, weight gain, fine tremors, polyuria, goiter and hypothyroidism, renal toxicity

True or false: It is okay to increase water intake while on Lithium.

False

Interventions to help GI upset on Lithium?

Take with meals

True or false: Lithium is category D and should be avoided in pregnancy.

True

What are the signs and symptoms of early lithium toxicity (1.5 mEq/L)?

Severe N/V/D, coarse tremors, neuro symptoms (slurred speech, blurred vision, muscle weakness, decreased coordination, EKG changes.

What are the signs and symptoms of late lithium toxicity (2.5 mEq/L)?

Severe HTN, severe polyuria, dilute urine progressing to oliguria, ataxia, giddy, tinnitus, blurriness, colonic movement, stupor—seizure—coma—death

What does Lithium interact with?

Diuretics, NSAIDs and anticholinergics

How frequently should serum lithium levels be checked?

Q 6-8 weeks

What labs should be monitored while on Lithium?

Creatinine, thyroid hormones, cbc, renal function q 6 months

What thyroid symptoms should you tell your patient to monitor for on Lithium?

Dry skin, constipation, bradycardia, hair loss, cold intolerance

When is Valproic acid used?

When lithium has failed.

What are the side effects of Valproic acid?

N/v (take with food), hepatotoxicity (anorexia, jaundice, abdominal pain/monitor LFT), pancreatitis, thrombocytopenia, hyperandrogenism (polycystic ovary), fetal toxicity

Carbamazepine (Tegretol) and Lamotrigine (Lamictal) are what type of drug?

Antiepileptic

Carbamazepine (Tegretol) side effects

Dizziness, drowsiness, tremor, visual disturbances, n/v, fetal toxicity, bone marrow suppression, cardiac effects, monitor LFT

Lamotrigine (Lamictal) side effects?

Rash (high risk in children, 2-8 weeks after initiation of drug) dizziness, n/v.

What are antipsychotic drugs used for?

Control symptoms during manic episodes, long term to stabilize mood, benefits patients with or without psychotic symptoms, can be combined with mood stabilizer