mood stabilizers & seizures Flashcards
mood stabilizers: use (2)
- prevent, relieve symptoms during manic, depressive episodes (bipolar affective disorder)
- relieve, prevent recurrence of labile mood in non-bipolar
lithium mnemonic
” when sodium is displaced, lithium takes its placed, and kidneys go to waste! “
lithium
mood stabilizer
gold standard for treating bipolar affective disorder
lithium
+ more recently, divalproex (depakote)
lithium: moa
alters distribution of neuron ions
– interchangeable with Na
modulates synaptic transmissions
– stabilizes neuron electrical activity
- influences excitatory second messenger systems
- decreases neuronal activity
- depends on renal function: RAPID RENAL EXCRETION
lithium: toxicity
usually involves kidneys (RAPID RENAL EXCRETION)
- sodium depletion causes accumulation
- dehydration causes retention
lithium: plasma levels (3)
0.8 - 1.4 mEq/L initial treatment (during acute phase)
0.4 - 1.0 mEq/L maintenance (during stable phase)
> 1.5 mEq/L toxic
lithium: dosing
individualized to plasma levels
- 300 mg TID/QID, max = 1200 mg
- ER form = BID
lithium: monitoring
annual: CBC, electrolytes, renal and thyroid function, hepatic function if indicated
lithium: interactions (list)
diuretics anticholinergic meds NSAIDs theophylline muscle relaxants used during anesthesia SSRIs
lithium: interaction with thiazide, loop
DIURETIC. may increase Li levels
lithium: interaction with osmotic, K-sparing
DIURETIC. may decrease Li levels
lithium + SSRI = ?
interaction: serotonin syndrome
lithium: adverse effects
- early: transient (HA, GI, muscle weakness, fatigue, confusion)
- general (tremor, goiter/hypothyroidism, renal toxicity, fetal effects)
- persistent (polyuria, polydypsia)
- other effects @ therapeutic levels: weight gain, decrease in WBC, cardiac (EKG changes)
pregnancy or breastfeeding + lithium = ?
DON’T DO IT
lithium: toxicity - most common s/s
n, v, d
lithium: toxicity - early s/s
thirst, polyruria
lethargy, slurred speech
muscle twitching, fine tremor
lithium: toxicity - progressive s/s
progressive s/s oliguria, anuria confusion, impaired consciousness poor coordination, frank twitching, seizures blurred vision, tinnitus coma -> death
lithium: mild-moderate toxicity treatment
mild-moderate (1.5 - 2)
HOLD med, check levels, re-evaluate dosage
lithium: severe toxicity treatment
> 2
STOP med, increase excretion (emetic, lavage, meds), renal dialysis
lithium: assess these before beginning
health status renal, thyroid function CBC electrolytes baseline EKG
lithium: key educational points
dietary sodium
illness associated with n, v, fever
abrupt changes in activity
seizure vs convulsion
“seizure” is often used interchangeably with “convulsion”
seizure: physical findings, changes in behavior after episode of abnormal electrical activity in brain
convulsion: body shakes rapidly, uncontrollably; muscles contract and relax repeatedly
can have seizure without convulsion
seizure pathophysiology
remember: uncontrollable, excessive electrical discharge of neurons
extracellular calcium =
long-lasting depolarization =
opens sodium channels =
high frequency bursts of action potentials
propagates through multiple synchronized neurons
