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24 Cards in this Set

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mood stabilizer
prototype: lithium carbonate
mood stabilizer MOA
produces neurochemical changes in the brain, including serotonin receptor blockade
mood stabilizer use
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
mood stabilizer adverse
GI distress
fine hand tremors
polyuria
weight gain
renal toxicity
goiter and hypothyroidism with long-term use
bradydysrhythmia, hypotension, electrolyte imbalances
early indications of lithium toxicity
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
advanced indications of lithium toxicity
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
severe indications of lithium toxicity
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
lithium toxicity severe
greater than 2.5 mEq/L
rapid progression of symptoms leading to coma and death
hemodialysis
lithium contraindications (mood stabilizer)
teratogenic, breast feeding, renal dysfunction, heart disease, sodium depletion, dehydration
mood stabilizer (lithium) interactions
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
lithium administration
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
Antiepileptic drugs
prototype: carbamazepine (Tegretol, Equetro)
valproic acid (Depakote)
antiepileptic drugs
lamotrigine (Lamictal)
antiepileptic drugs
antiepileptic MOA
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
antiepileptic uses
treatment of mania and depressive episodes
antiepileptic adverse (carbamazepine)
cognitive function is minimally affected
CNS effects: nystagmus, double vision, vertigo, staggering gait, headache
blood dyscrasias
teratogenesis, hypo-osmolarity, skin disorders

administer at bedtime
lamotrigine (antiepileptic) adverse
double or blurred vision
dizziness, headache, nausea, vomiting
serious skin rashes
valproic acid (antiepileptic) adverse
GI effects, hepatoxicity, pancreatitis, thrombocytopenia, teratogenesis
antiepileptic contraindications
carbamazepine- bone marrow suppression
valproic acid- liver disorders
antiepileptic interactions (carbamazepine)
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
antiepileptic interactions (lamotrigine)
carbamazepine, phenytoin, and phenobarbital decrease effects
valproic acid inhibits med metabolizing enzymes and increases the half-life of lamotrigine
antiepileptic interactions (valproic acid)
concurrent use of valproic acid increases the levels of phenytoin and phenobarbitol
antiepileptic effectiveness
relief of acute manic symptoms
improvement of mood
ability to perform ADls
improved sleeping and eating habits
greater interaction with peers