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Psychiatric Meds.

Medications for Bipolar Disorders

What is the mood stabilizer? Lithium Carbonate
What are the therapeutic uses for Lithium? Treatment of Bipolar Disorders (controls episodes of acute mania and decreases the incidence of suicide), Alcoholism, Bulimia, Schizophrenia
What are the side/adverse effects of Lithium? GI distress; Fine hand tremors; Polyuria, mild thirst; Weight gain; Renal toxicity (assess BUN and creatinine); Goiter and hypothyroidism; Electrolyte imbalances
Lithium Toxicity: Early Signs Less than 1.5 mEq/L: diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, slurred speech
Lithium Toxicity: Advanced Signs 1.5-2.0 mEq/L: Mental confusion, poor coordination, coarse tremors, ongoing GI distress including nausea, vomiting, and diarrhea
Lithium Toxicity: Severe Toxicity Greater than 2.0-2.5 mEq/L: Extreme polyuria of dilute urine, tinnitus, blurred vision, ataxia, seizures, severe hypotension leading to coma, and possible death from respiratory complications
Lithium Toxicity: Severe-Severe Greater than 2.5 mEq/L: Rapid progression of symptoms leading to coma and death (Hemodialysis may be warranted)
Contraindications for Lithium Teratogenic, especially during the first trimester of pregnancy. Discourage breastfeeding.
Interactions with Lithium Diuretics (with decreased serum sodium, lithium excretion is decreased, which can lead to toxicity); Avoid ASAIDs (ibuprofen); use aspirin as a mild analgesic Avoid anticholinergics (antihistamines, tricyclic antidepressants)
Nursing Administration with Lithium Initial Treatment: levels should be between 0.8-1.4 mEq/L Maintenance Range: 0.4-1.0 mEq/L Plasma Levels: >1.5 mEq/L can result in toxicity Lithium effects begin within 7-14 days
What are the Mood-Stabilizing Antiepileptic Drugs (AEDs)? Carbamazepine (Tegretol); Valproic acid (Depakote); Lamotrigine (Lamictal)
What are the therapeutic uses for AEDs? Used to treat manic and depressive episodes; particularly useful in clients with mixed mania and rapid cycling bipolar disorders.
Side/Adverse Effects of Carbamazepine (Tegretol) CNS effects (nystagmis, double vision, vertigo, staggering gait, headache) Blood dyscrasias (leukopenia, anemia, thrombocytopenia) Teratogenesis Hypo-osmolarity Skin disorders (wear sunscreen)
Side/Adverse Effects of Valproic Acid (Depakote) GI effects; Hepatotoxicity (anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice); Pancreatitis; Thrombocytopenia; Teratogenesis
Side/Adverse Effects of Lamotrigine (Lamictal) Double or blurred vision, dizziness, headache, nausea, vomiting Skin rashes (could include Stevens-Johnson Syndrome)
Interactions with Carbamazepine (Tegretol) Oral contraceptives; warfarin (Coumadin); Grapefruit juice; Phenytoin, phenobarbital
Interactions with Valproic Acid (Depakote) Phenytoin, phenobarbital
Interactions with Lamotrigine (Lamictal) Carbamazepine, phenytoin, phenobarbital; Valproic Acid
Created by: j_bressette