ANTIMANIC DRUGS

Mood stabilizers

TREATMENT GOALS FOR BIPOLAR DISORDER

• Remission• Prevention• Return to premorbid function

SIGNS AND SYMPTOMS OF BIPOLAR DISORDER – MANIA

Elevated moodIncreased in activitiesFlight of ideasRacing thoughtsInflated self-esteemDecreased need for sleepAgitationMore talkative than is usualPacing, hand wringling

Extreme restlessnessLoses temper oftenSignificant irresponsible behaviorIncreased goal-directed activities (sexual, social)Impaired excessive, involvement in pleasureable activities, with high potential for painful consequencesDelusions

LITHIUM

• Used to treat bipolar disorder by stabilizing the client’s mood, preventing or minimizing the highs and lows that characterize bipolar illness

Mechanism of action

• Inhibits the release of norepinephrine, serotonin, and dopamine while facilitating their reuptake into presynaptic terminals

Therapeutic drug serum level: 0.6 – 1.2 mEq/L

• Serum lithium levels should be checked every 1 – 2 months or whenever any behavioral change suggests an altered serum level• Blood samples to check serum lithium levels should be drawn in the morning, 12 hours after the last dose was taken

CLIENT TEACHING

• Administer medication with food – minimize GI irritation

• Instruct client to maintain fluid intake of 6 – 8 glasses of water a day

• Instruct client to avoid excessive amounts of coffee, tea or cola

• Instruct client to maintain adequate salt intake

• Do not administer diuretics while the client is taking lithium

• Avoid alcohol• Avoid OTC• Client may take a missed dose within 2 hours

of the scheduled time; otherwise, the client should skip the missed dose and take the next dose at the scheduled time

CLIENT TEACHING

• Do not adjust the dosage without consulting the physician – lithium should be tapered off and not discontinue abruptly

• Instruct signs and symptoms of lithium toxicity• Notify physician if polyuria, prolonged

vomiting, diarrhea or fever occur

CLIENT TEACHING

• Therapeutic response to the medication will be noted 1 – 3 weeks

• Monitor electrocardiogram, renal function tests, and thyroid tests

CLIENT TEACHING

Lithium Toxicity• Occurs when ingested lithium cannot be

detoxified and excreted by the kidneys• Serum lithium level : 1.5 mEq/L and

above

Therapeutic Serum Levels (0.6 -1.2 mEq/L)

Mild to Moderate Toxicity (1.5 – 2 mEq/L

Moderate to Severe Toxicity (2 – 3 mEq/L)

Severe Toxicity (>3mEq/L)

Hand tremor (fine)Memory problemsGoiterHypothyroidismMild diarrheaAnorexiaNauseaWeight gainPolydipsia, polyuria

DiarrheaVomitingDrowsinessDizzinessHand tremor (coarse)Muscular weaknessLack of coordinationDry mouth

Previous symptoms and:GiddinessTinnitusBlurred visionLarge output of dilute urineDeliriumNystagmus

Previous symptoms and:SeizuresOrgan failureRenal failureComaDeath

Interventions:

–Hold lithium and notify physician–NO ANTIDOTE is available–Monitor V/s and LOC–Monitor cardiac status

–Prepare to obtain lithium level; electrolytes, BUN, creatinine level and CBC–Gastric lavage–Parental normal saline–Forced dieresis or hemodialysis

Interventions:

INTERACTIONS

Can elevate lithium serum levels

• Diuretics (except acetazolamide)• NSAIDs• Low salt diet after treatment

commences

Can decrease serum lithium levels

–Acetazolaminde (Diamox)–Caffeine–Alcohol

ANTICONVULSANTS

Valproates

• Used as an antiepilectic agent• Increase in the inhibitory role of

GABA• Suppression of sodium influx into

the neuron• Suppression of calcium influx

through specific calcium channels

–Advantages:•Have a rapid onset•Can be used initially without

attempting lithium and are well-tolerated with little effect on cognition

–Disadvantages:• Transient hair loss•Weight gain• Tremors•GI upset•Dose-related thrombocytopenia

Carbamazepine–Effective for most patients who do not

respond to lithium or to the valproates–Has a faster onset of action compared

with lithium

–Side effects:•Nausea•Anorexia•Occational vomiting• Sedation and drowsiness•Agranulocytosis – most serious

potential side effect

Lamotrigine• Approved for the treatment of bipolar disorder

including bipolar depression

• manipulating the GABA system, thus inhibiting neuronal firing• blocking of voltage-gated sodium and calcium

channels, further inhibiting neuronal conduction• believed to inhibit the excitatory neurotransmitter

glutamate

Oxcarbazepine

–Does not cause some of the more serious adverse reactions associated withcarbamazepine–Commonly prescribed agent for

bipolar disorder

Gabapentin

–Tends to be used in an adjunctive role and not as monotherapy–It is believed to be particularly

effective if the patient also experiences anxiety

Topiramate

• It increases GABA activity, blocks voltage-gated sodium and calcium channels, and inhibits the excitatiryneurotransmitter glutamate

ANTIPSYCHOTICS

• Olanzapine• Risperidone• Quetiapine• Ziprasidone• Clozapine• Aripiprazole