Mental Health- Mood Stabilizing Medications

Mood stabilizing Medications
– Lithium carbonate (Carbolith)

Lithium carbonate (Carbolith) (Indications)
– Bipolar disorders, especially the manic phase

Lithium carbonate (Carbolith) (Adverse reactions)
– Nausea, fatigue, thirst, polyuria, and fine hand tremors
– Weight gain
– Hypothyroidism
– Early signs of toxicity: diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination
– possible renal impairment

Lithium carbonate (Carbolith) (Nursing Implications)
– Therapeutic level range from 0.5 to 1.5.
– Excreted by the kidneys. Maintain adequate serum levels
– Assess electrolytes, especially sodium.
– Baseline studies of renal, cardiac and thyroid status must be obtained before therapy is begun
– Teach the client early symptoms of toxicity. If drug is continued, coma, convulsions, and death may occur.
– instruct client to keep salt usage consistent
– Use with diuretics is contraindicated. Diuretic-induced sodium deletion can increase levels causing toxicity.

Anticonvulsant Mood Stabilizers
– Valproic acid (Depakene)
– Carbamazepine (Tegretol)
– Phenytoin (Dilantin)
– Lamotrigine (Lamictal)

Valproic acid (Depakene) (Indications)
– Used in bipolar disorder alone or with lithium

Valproic acid (Depakene) (Adverse reactions)
– GI distress: nausea, anorexia, vomiting
– Hepatotoxicity
– Neurologic symptoms: tremor, sedation, headache, dizziness

Valproic acid (Depakene) (Nursing Implications)
– Administer with food
– Monitor blood levels
– Maintain serum levels 50-125 ug/mL

Carbamazepine (Tegretol) (Indications)
– Used in bipolar disorders
– Used as alternative to lithium

Carbamazepine (Tegretol) (Adverse Reactions)
– Dizziness
– Ataxia
– Blood dyscrasias

Carbamazepine (Tegretol) (Nursing Implications)
– Maintain serum levels at 8-12 g/mL
– Stop drug if WBC drops below 3000/mm^3 or neutrophil count goes below 1500/mm^3
– Monitor hepatic and renal function

Phenytoin (Dilantin)
– Therapeutic levels range from 10 to 20 mcg/L

lamotrigine (Lamictal) (Indications)
– Used in bipolars alone or with other mood stabilizers

lamotrigine (Lamictal) (Adverse Reactions)
– Headache
– Dizziness
– Double Vision
– Rash (Steven-Johnson syndrome)

lamotrigine (Lamictal) (Nursing Implications)
– To minimize risk of severe rash, give low dosage, 25-50 mg/day initially, then gradually increase to maintenance dose of 200 mg/day (alone) or 100 mg/day (w/ valproate) or 400 mg/day (w/ Carbamazepine)

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