Lithium And Mood Stabilisers Flashcards
Lithium indications for use
Used in the prophylaxis & treatment of bipolar disorder and mania.
Its use in prophylaxis makes it a little different from other psychotropic medications
What can it be used to treat
Used to treat depression with other antidepressants if an incomplete response is achieved
How many months after starting lithium does the full prophylactic effect not occur for ?
It may not occur for 6 months
How does lithium take to work
1wk to 10 days to have a therapeutic effect .
What is needed prior to commencing lithium
Physical work up needed ,including ECG
Baseline thyroid function tests and renal function and baseline weight / BMI measurement .
What disorder can lithium cause
Thyroid
What levels should the lithium be in the blood
Between 0.4 -1mmol / litre
What lithium levels in the blood be at for those experiencing an acute manic episode or for those who have relapsed
0.8-1 mol/ litre
When can lithium be toxic
Over 1mmol/litre and fatal over 1.5mmol litre
Lithium levels over 2mmol/litre requires urgent treatment which may include haemodialysis
When should serum lithium levels be taken
10-12 hours after the last dose of lithium but before the first dose of the day.
Contraindications
Renal disease,cardiovascular disease and severe dehydration
How long should it be reduced when discontinuing
Gradually over a period of at least 4 weeks or reduce impact of a withdrawal syndrome .
Side effects
Tremor ,nausea,vomitting ,dry mouth,weight gain,diarrhoea ,skin and hair changes
Causes of lithium toxicity
Caused by decreased excretion of the drug ,dehydration,decrease in renal function ,increased sweating , can be caused by deliberate overdose
Who is lithium toxicity more common in ?
In the elderly ,those with congestive,heart failure or renal impairment ,acute lithium toxicity has a mortality rate of approx 25%
Symptoms of toxicity
Pronounced tremor , vomitting ,diarrhoea,blurred vision ,tinnitus ,weakness,apathy,muscle twitching
In severe cases convulsions,coma,renal failure
Treatment of toxicity
Stop lithium immediately
Increase fluid intake to promote urinary output
Sever cases ( usually over 2-4 mol/L)
Haemodialysis
Nursing considerations
Patient education regarding weight gain
The different brands of lithium ,lithium carbonate and lithium citrate
These two should not be mixed as they lead to toxicity
Liquid should not be substituted for tablets unless prescribed
Advice re taking lithium while pregnant
Mood stabilisers
Antipsychotics
Benzodiazepines
Antidepressants
Anticonvulsants
Antipsychotics
Caution re toxicity
Benzodiazepines
Caution re dependence
Antidepressants
Caution re rapid cycling bipolar
Anticonvulsants
Caution re increase in suicidal behaviour
Sodium valproate
Sodium valproate ( epilim ) and valproic acid ( depakote) are anticonvulsants used in treatment of bipolar disorder and mania .
Side effect
Nausea
Weight gain
Increased appetite
Gastric irritation
What does it mean when saying it’s a highly teratogenic drug
It’s used in pregnancy and is linked to congenital and neurodevelopmental disorders
Girls and women of child bearing age should not be prescribed it unless on highly effective contraception it should be reviewed regularly by specialists
Carbamazepine
An anticonvulsants also used in treatment of bipolar disorder and mania
Has sedative effects which may be beneficial in mania
Has anti aggressive and irritability properties
Side effects
Nausea ,vomitting,dizziness ,skin rashes
Blood monitoring
Monthly and three monthly
What drugs can carbamazepine interact with
Oral contraceptives and many psychotropic drugs
Antidepressants,hypnotics,tranquillisers
