Medications for Bipolar Disorders
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| What is the mood stabilizer? | Lithium Carbonate
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| 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
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| 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
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| Lithium Toxicity: Early Signs | Less than 1.5 mEq/L:
diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, slurred speech
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| Lithium Toxicity: Advanced Signs | 1.5-2.0 mEq/L:
Mental confusion, poor coordination, coarse tremors, ongoing GI distress including nausea, vomiting, and diarrhea
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| 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
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| Lithium Toxicity: Severe-Severe | Greater than 2.5 mEq/L:
Rapid progression of symptoms leading to coma and death
(Hemodialysis may be warranted)
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| Contraindications for Lithium | Teratogenic, especially during the first trimester of pregnancy.
Discourage breastfeeding.
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| 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)
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| 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
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| What are the Mood-Stabilizing Antiepileptic Drugs (AEDs)? | Carbamazepine (Tegretol); Valproic acid (Depakote); Lamotrigine (Lamictal)
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| 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.
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| 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)
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| Side/Adverse Effects of Valproic Acid (Depakote) | GI effects; Hepatotoxicity (anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice); Pancreatitis; Thrombocytopenia; Teratogenesis
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| Side/Adverse Effects of Lamotrigine (Lamictal) | Double or blurred vision, dizziness, headache, nausea, vomiting
Skin rashes (could include Stevens-Johnson Syndrome)
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| Interactions with Carbamazepine (Tegretol) | Oral contraceptives; warfarin (Coumadin); Grapefruit juice; Phenytoin, phenobarbital
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| Interactions with Valproic Acid (Depakote) | Phenytoin, phenobarbital
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| Interactions with Lamotrigine (Lamictal) | Carbamazepine, phenytoin, phenobarbital; Valproic Acid
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