Mood Stabilizers Flashcards
Lithium Contraindication
Liver/Renal dz, pregnant/lactating, severe CVD/dehydration, brain tumor/damage, Na+ depletion, children<12yo; Caution with TSH dz
Lithium Drug-Food interaction
Increase Na+ intake, as lithium can deplete Na+
Lithium Drug-Drug interaction
Lithium higher with thiazide diuretics, methyldopa, haloperidol, NSAIDs, antidepressants, carbamazepine, theophylline, aminophylline, sodioum bicarbonate, phenothiazine
Lithium Lab effects
Increase blood/urine glucose/protein; decrease serum Na+
Lithium S/E
HA, lethargy, drowsiness, dizziness, tremors, slurred speech, dry mouth, anorexia, vomitting, diarrhea, polyuria, hypotension, abd pain, muscle weakness, restlessness
Lithium A/E
Urinary incontinence (check for fluid deficit d/t polyuria), hyponatremia, clonic movements, stupor, azotemia (high waste: BUN, Cr), leukocytosis, nephrotoxicity
Lithium life-threatening effect
cardiac dysrhythmias, circulatory collapse (failure to deliver/take away O2, nutrients, wastes to/from tissues)
Who can’t have Lithium?
pts with suicidal ideation
Evaluate what s/s for lithium?
neurologic status, gait, LOC, reflexes, tremors
What labs do run/check for lithium? How often to run?
LFTs, RFTs; draw weekly intitially then q 1-2mon
s/s of lithium toxicity at 1.5-2.0 mEq/L; what do you do?
MILD toxicity at 2.0 : N/V/D, ataxia, blurred, tinnitus; Do: increase Na or decrease dose
s/s of lithium toxicity at 2-3.5 mEq/L. What do you do?
Moderate toxicity at 3.0: excessive UO of dilute urine, increasing tremors, muscular irritability, psychomotor retardation, confusion, giddiness. Give NS d/t pt need salt.
s/s of lithium toxicity at 3.5+ mEq/L; what do you do?
LIFE THREATENING: impaired consciousness, nystagamus, seizures, coma, oliguria/anuria, cardiac dysrhythmias, myocardial infarction, cardiovascular collapse. Hold meds and notify MD. Pt needs ICU or dialysis
Evaluate what sort of drug history for pt on lithium? Why?
diuretics, NSAIDs, tetracyclines, methyldopa, probenecids cause decreased renal clearance and accumulation of lithium
depressive s/s
mood changes, insomnia, apathy, lack of interest in activities
Teach what about lithium
if stopped, manic s/s will reappear. Adhere to follow-up visits to check levels and drug efficacy. Notify MD r/t OTC. No dangerous mechanical activity until Lithium level is established. Fluid intake of 2-3L/day initially then 1-2L/day maintenance; increase H2O during hot weather. Take with meals for less GI irritation. See effectiveness of lithium start in 1-2 wks. Report to MD if planning to conceive d/t teratogenic effects on fetus. Wear a bracelet r/t lithium Rx. Avoid caffeine d/t aggrevate manic phase of bipolar d/o. Adequate Na intake. No crash diets. Early s/s of toxicity: diarrhea, drowsiness, loss of appetite, muscle weakness, n/v, slurred speech, trembling. Late s/s of toxicity: blurred vision, confusion, increased urination, convulsions, severe trembling, unsteadiness.
If lithium is stopped,
manic s/s will reappear.
tell pt to adhere to
follow-up visits to check levels, labs, drug efficacy.
Notify MD about
OTC, early/late s/s of toxicity, if planning pregnancy d/t teratogenic effects on fetus
how much fluid should pt on lithium take?
2-3L/day initially then 1-2L/day maintenance; increase fluids during hot weather.
take lithium with
meals to decrease GI irritation
Avoid what with lithium
caffeine d/t aggravation of manic phase, crash diets d/t sodium depletion; operating dangerous mechanical acitivity until lithium levels are stable
When do you see lithium start to take effect?
1-2 weeks after start of tx.
Early s/s to report with lithium
diarrhea, drowsiness, loss of appetite, muscle weakness, nausea, vomitting, slurred speech, trembling
late s/s to report with lithium
blurred vision, confusion, increased urination, convulsions, severe trembling, unsteadiness
when do pts stop taking lithium?
when pt has period of emotional stability
pharmacokinetics of lithium
mets in liver; most excreted unchanged in urine
what can you use in place of lithium?
anticonvulsants such as carbamazepine tegretol, lamotrigine lamictal, divaproex/valproic acid depakote/kene, gabapentin (neurontin)
continuous lithium + NSADs =
cardiac sick sinus rhythm
with lithium, if Na is up
lithium is down
with lithium, if lithium is up
Na is down
half life of lithium
24 hrs
half life of lithium for elderly
36 hrs, so look for cumulative drug action
lithium treats
bipolar manic depressive psychosis, manic episodes
lithium action
alter ion transport in muscle/nerve cells; increased receptor sensitivity to serotonin
valproic acid depakote/kene a/e
CNS depression, hepatotoxicity
valproic acid depakote/kene therapeautic range for acute mania
50-125mcg/mL in blood serum
valproic acide depakote/kene MAX dose
60mg/kg/day
at what level does valproic acid depakote/kene cause CNS depression
200mcg/mL
at what level does valproic acid depakote/kene cause multiorgan toxicity
400mcg/mL
what is the antidote for valproic acid depakote/kene?
L-carnitine
L-carnitine is an antidote for?
valproic acid depakote/kene
at what level does valproic acid depakote/kene kill?
750+ mcg/mL
carbamazepine tegretol treats
bipolar I, acute mania or mixed episode
what are a/e of carbamazepine tegretol?
hyper/hypotension, PRURITIC RASH, Steven-Johnson Syndrome skin slough off (tx like burn pt), Toxic Epidermal necrolysis targetoid lesion (red/raw); nephrotoxicity (THE KIDNEY GOES 1ST), hyponatremia (s/s confusion, seizure at 119)
lamotrigine lamictal treats
maintenance tx for mania
lamotrigine lamictal life threatening s/s
RASH; Steven-Johnson Syndrome skin slough off, Toxic epidermal necrolysis targetoid lesion (red/raw); tx like burn pt
List two types of mood stabilizers
lithium and off label use of anticonvulsants
why would pt NOT want to take mood stabilizers
they want to keep their highs
