Ati Nervous System Meds (Bipolar Disorders)

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mood stabilizer

Back 1

prototype: lithium carbonate

Front 2

mood stabilizer MOA

Back 2

produces neurochemical changes in the brain, including serotonin receptor blockade

Front 3

mood stabilizer use

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bipolar disorders- controls episodes of acute mania, helps prevent the return of mania or depression, and decreases incidence of suicide
alcohol use disorder
bulimia
psychotic disorder

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mood stabilizer adverse

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GI distress
fine hand tremors
polyuria
weight gain
renal toxicity
goiter and hypothyroidism with long-term use
bradydysrhythmia, hypotension, electrolyte imbalances

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early indications of lithium toxicity

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less than 1.5 mEq/L
diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, fine hand tremor, slurred speech

Advise client to withhold meds and notify provider
administer new dosage based on lithium levels

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advanced indications of lithium toxicity

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1.5-2.0 mEq/L
GI distress, mental confusion, poor coordination, coarse tremors
withhold meds, administer new dosage based on levels
if manifestations are severe- possibly promote excretion

Front 7

severe indications of lithium toxicity

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2.0-2.5 mEq/L
extreme polyuria of dilute urine, tinnitus, blurred vision, ataxia, seizures, severe hypotension, leading to coma and possibly death from respiratory complications

give alert clients an emetic
perform gastric lavage or adminster urea, mannitol, or aminophylline to increase rate of excretion

Front 8

lithium toxicity severe

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greater than 2.5 mEq/L
rapid progression of symptoms leading to coma and death
hemodialysis

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lithium contraindications (mood stabilizer)

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teratogenic, breast feeding, renal dysfunction, heart disease, sodium depletion, dehydration

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mood stabilizer (lithium) interactions

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sodium is excreted with the use of diuretics, reduced sodium decreases lithium excretion , which can lead to toxicity
NSAIDS (ibuprofen), celexicob (Celebrex)- increases renal reabsorption of lithium- leading to toxicity
anticholinergics (antihistamine, TCAs) can induce urinary retention and polyuria

Front 11

lithium administration

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maintenance level 0.4-1.0 mEq/L
plasma levels greater than 1.5 can result in toxicity
effects begin in 7-14 days
must be administered in 2-3 doses daily due to a short half-life
take with food to decrease GI distress

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Antiepileptic drugs

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prototype: carbamazepine (Tegretol, Equetro)

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valproic acid (Depakote)

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antiepileptic drugs

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lamotrigine (Lamictal)

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antiepileptic drugs

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antiepileptic MOA

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slows entrance of calcium and sodium back into the neuron , potentiates inhibitory effects of gaba butyric acid, inhibiting glutamic acid which in turn suppresses CNA excitation

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antiepileptic uses

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treatment of mania and depressive episodes

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antiepileptic adverse (carbamazepine)

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cognitive function is minimally affected
CNS effects: nystagmus, double vision, vertigo, staggering gait, headache
blood dyscrasias
teratogenesis, hypo-osmolarity, skin disorders

administer at bedtime

Front 18

lamotrigine (antiepileptic) adverse

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double or blurred vision
dizziness, headache, nausea, vomiting
serious skin rashes

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valproic acid (antiepileptic) adverse

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GI effects, hepatoxicity, pancreatitis, thrombocytopenia, teratogenesis

Front 20

antiepileptic contraindications

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carbamazepine- bone marrow suppression
valproic acid- liver disorders

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antiepileptic interactions (carbamazepine)

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decreases effects of oral contraceptives and warfarin
grapefruit juice inhibits metabolism which increases levels of carbamazepine
phenytoin and phenobarbital decrease the effects of carbamazepine by stimulating metabolism

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antiepileptic interactions (lamotrigine)

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carbamazepine, phenytoin, and phenobarbital decrease effects
valproic acid inhibits med metabolizing enzymes and increases the half-life of lamotrigine

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antiepileptic interactions (valproic acid)

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concurrent use of valproic acid increases the levels of phenytoin and phenobarbitol

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antiepileptic effectiveness

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relief of acute manic symptoms
improvement of mood
ability to perform ADls
improved sleeping and eating habits
greater interaction with peers