Mood Stabilizers Flashcards
Biogenic Amine Hypothesis
Chronobiologic Theories
Sensitization and Kindling theory
Genetic Factors
Theories of Mood Disorders (Bipolar Disorder)
Monoamine – neurotransmitters for depression & mania (specific)
Biogenic Amine Hypothesis
Circadian rhythm related
Chronobiologic Theories
Electrical storm of sensitization in the brain & kindling – more action potential stuff happening, brain is ready to have rapid firing (kindled and ready to go) – affects all parts of the brain (hypothalamus is controlled by where mood and kindling is controlled). This is why antiseizure medications are used to treat bipolar disorder – this theory is why
Sensitization and Kindling theory
Strong likelihood of genetic factors – if family members have schizophrenia, higher risk of bipolar
Genetic Factors
Anti-Mania medications (mood stabilizer medications)
Anticonvulsant medication
Antipsychotic medication
Treatment of Bipolar Disorders
______ is anti-mania medication
Lithium
Generally used short term, acute episodes vs long term maintenance use
Antipsychotic medication
Anti-mania
lithium carbonate (Carbolith)
Used to be used as a table salt – ________ toxicity
Has relationship w sodium
lithium
Modify nerve cell function
Also thought to increase the level of inhibitory neurotransmitter GABA (Gamma- aminobutyric acid)
Anticonvulsants - Drugs that Suppress Sodium Influx
Decrease dopamine levels when a person is experiencing mania
Often used in combination with other mood stabilizers
Antipsychotics
May be administered concurrently with mood stabilizers to treat Acute Bipolar I Disorder with Depressive Symptoms AND Acute Bipolar II Disorder with Depressive Symptoms
Need to be administered with the mood stabilizer
medications to prevent rapid cycling from depression to mania
Antidepressants
ANTIDEPRESSANTS USED AS _________ FOR MOOD STABILIZATION:
Selective Serotonin Reuptake Inhibitors
Selective Serotonin and Norepinephrine Reuptake Inhibitors
Atypical Antidepressants (bupropion, mirtazapine, trazadone & moclobemide)
ADJUNCTS
Antidepressants used with caution – More common with Acute ___________
More common with bipolar II because more depressive symptoms – not fully mania
Should be administered concurrently w a mood stabilizer
Bipolar II
ABSORPTION
GI Tract
DISTRIBUTION
Same as water **
Crosses the blood brain barrier slowly
Widely distributed through the body
METABOLISM
Liver
EXCRETION
Kidneys
Usually 80% of filtered Lithium is reabsorbed **
Cross placenta and enter breast milk
Lithium
Does not bind to serum proteins – nonprotein binding
Long term use can be very disruptive to the kidneys. Toxicity WILL damage the kidneys – there is a cumulative effect with each time they get into toxicity.
Lithium
Low salt intake, dehydrated, low sodium concentration in the blood – then MORE than the 80% of _____ will be reabsorbed. Increases levels and increased levels of toxicity.
Lithium
Acute: 900- 2400 mg
Maintenance: 400 – 1200mg
Lithium carbonate
Lithium
Valproic acid/Divalproex (Epival)
Paliperidone (Invega)
Risperidone (Risperdal)
Quetiapine (Seroquel)
Aripiprazole (Abilify)
Asenapine (Saphris)
1st Line Acute Mania Treatment Options
Lithium
Valproic acid/Divalproex
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Quetiapine + Lithium or Divalproex
Aripiprazole + Lithium or Divalproex
Aripiprazole
1st Line Maintenance Treatment Options
Serum Drug Levels are required with LiCO3
Baseline bloodwork:
- Renal
- Cardiac
- Thyroid
- Electrolytes
Lithium Carbonate (LiCO3)
Upon initiation of LiCO3 - blood levels are required q 2- 3 days
Maintenance: every couple of months (if stable)
Lithium blood levels are best done 8 to 12 hours after the last dose
Acute Therapeutic Range is 0.6 – 1.2 mEq/L (mmol/L)
Maintenance Therapeutic Range 0.6-1.0mEq/L
Lithium Carbonate (LiCO3)
Lithium and ________ are monovalent positive ions
Sodium levels need to be taken on a regular basis
Sodium levels should remain normal (135-145 mmol/L)
Patients should be advised to maintain a normal salt intake and to avoid over-hydration or dehydration
Sodium
decreases lithium level
Overhydration
increases lithium level
Dehydration
Abdominal pain
Tremor of hands
Fatigue
GI upset
Vertigo
Weight gain
Thyroid abnormalities
ECG changes
Dermatological changes
<1.0 Lithium blood level
Polyuria
Increased drowsiness
Blurred vision
Muscular weakness
Tremors
Diarrhea
Vomiting
1.0-2.0 Lithium blood level
Confusion/disorientation
Delirium
Seizures
Nystagmus
Kidney failure
Tachycardia
Coma/death
> 2.0 Lithium blood level
Lithium toxicity ______ mEq/L (mmol/L)+
1.2-1.5
Toxicity Manifestations Include:
GI discomfort, tremor, confusion, fatigue, seizures and possibly death
Lithium Toxicity
Treatment:
Immediately notify the prescriber
Withhold Lithium
Obtain a Blood Sample to measure the lithium, sodium, and kidney function
Emergency medical treatment
Assess for neurological damage
IV hydration
Lithium Toxicity
Brain Damage
Conditions requiring reduced sodium intake
Renal Impairment
Cardiac Impairment
Lithium contraindications
NSAIDS
Thyroid Conditions
Psoriasis
Hypercalcemia
Diabetes
Parkinson’s Disease
Surgery – surgeon needs to be notified that the client is on Lithium
Cannabis
Lithium precautions
Lithium Toxicity Risk: Increases with _______ depletion and needs to be carefully monitored (vomiting, diarrhea, use of diuretics, heavy sweating etc.)
sodium
Alcohol/ diuretics
INCREASED dehydration/ fluctuating sodium levels
SSRI
INCREASED Risk of serotonin syndrome
Carbamazepine/phenytoin
INCREASED Risk of CNS toxicity
Haldol
INCREASED encephalopathy syndrome
Phenothiazines (Typical Antipsychotics)
INCREASED Risk for altered response from either drugs
Lithium Carbonate Interactions
Lithium and Haldol – contraindicated/great caution – increased risk of ____________
encephalopathy
___________ – increase dehydration / fluctuating sodium levels
Alcohol/diuretics
_________ – increase risk encephalopathy syndrome.
Encephalopathy is a group of conditions that cause brain dysfunction. Brain dysfunction can appear as confusion, memory loss, personality changes and/or coma in the most severe form.
- vision changes, headache, weakness, tremors, lethargy, shutting down and sleeping.
Haldol
__________ used in an acute episode – rapid tranquilization & increase safety of the person experience & and also the care provider
- mixed features of irritability can occur w mania
- not all sunshine and rainbows
- people may do impulsive things (try to fly) – risk of death, when people try to stop you and bipolar people can become hostile quickly
Haldol
Blood levels (renal intake and output & function, cardiac, electrolytes, thyroid) therapeutic effect at lowest dose (trough). Serum lithium levels – tolerable range and not in toxicity. Serum lipid levels (weight gain), waist circumference. Blood pressure (orthostatic hypotension).
Hydration is important because dehydration increases level of lithium in their body, increase in toxicity. Knowing about exercise and interests i.e., hot yoga.
Lithium toxicity signs. Earlier signs (aside from seizure). Any hint of lithium toxicity - so we can prevent irreparable damage.
Client teaching for Lithium
Lithium Carbonate
*Caution with clients with critical illness, renal, hepatic impairment - lower doses will be necessary
*Lithium level 0.4 to 0.6 in older adults
Older adult lithium considerations
