Mood stabilizer meds Flashcards
Mood Disorder Meds 4 categories
- Lithium
- Anticonvulsants
- Antipsychotics
- Benzodiazepines
Lithium general facts
- 1st line for bipolar
- 90% effective in “pure” mania
- Less effective for rapid-cycling
- Affects: dopamine, NE, 5-HT2, acetylcholine, GABA
- *Takes 7-10 days to control hyperactivity
- Meanwhile, give antipsychotics
Lithium effectiveness/moderate effectiveness
•Effective for: –Elation, grandiosity –Flight of ideas –Irritability/ manipulativeness –Anxiety •Moderately effective: –Insomnia –Psychomotor agitation –Assaultiveness –Attention Deficit/ distractability
Lithium mechanisms and contraindications
Works on electrolytes •**Not metabolized by liver, goes straight to kidney •**Affected by sodium/ fluid balance •**Narrow therapeutic index •Contraindicated: –Renal/ thyroid/ heart disease –Pregnancy –Diuretics –Many OTC meds
Lithium monitoring
- ESSENTIAL
- Draw blood 12 hours after dose
- 3 times a week
- Gradually decreasing
- Every 6 months for duration of treatment
- Include periodic renal/ thyroid tests
Lithium levels s/e’s
Lithium levels/ Side effects •Therapeutic (maintenance level): 0.5-1.2mEq/L •Expected S/E –Initial GI upset (take with meals) –FINE tremor –MILD polyuria, polydipsia –Increased WBC
Mild lithium toxicity
•Mild: approx 1.5mEq –Lethargy, decreased concentration –Weakness, slight ataxia –Coarse hand tremors –Return of GI upset
Moderate lithium toxicity
Moderate: 1.5-2.5mEq –Severe diarrhea, N/V –Moderate ataxia, weakness –Lethargy, slurred speech –Irregular tremor –Blurred vision
Severe lithium toxicity
•Severe: > 2.5mEq/L –Nystagmus –Dysarthria –Hyperreflexia –Hallucinations –Oliguria –Confusion/ seizures/ coma/ death
Lithium – client teaching
- Take with meals
- No diuretics – coffee
- Enough salt
- Toxic effects
- Bloodwork
- Weight control
- Don’t discontinue
Anticonvulsants info + examples
•Rapid cycling •Action not known •Examples: –Divalproex (Depakote) –Carbemazepine (Tegretol) –Gabapentin (Neurontin) –Lamotrigine (Lamictal)
Anticonvulsants general s/es
- Drowsiness/ fatigue
- Drug interactions: **oral contraceptives
- Stevens-Johnson syndrome
Carbemazepine (Tegretol
•Agranulocytosis •More likely to cause S-J syndrome in Asians •14 days before peak effect seen •Labs for bone marrow/ hyponatremia: –Baseline –Every 2 weeks –Every 3 months
Divalproex (Depakote
•Increases GABA •Works in 1 – 2 weeks •May be hepatotoxic: baseline liver studies •Side effects: –Tremors –Weight gain –GI upset
Antipsychotics for Bipolar
Used to only be used to control hyperactivity while waiting for lithium to work
•Now can be used long-term instead of or in addition to lithium
Decrease hyperactivity, anxiety, psychosis of mania
•May also be used as an adjunct for severe depression
•Some approved drugs:
–Aripiprazole (Abilify)
–Quetiapine (Seroquel)
–Ziprasidone (Geodon) – cardiac implications
