Bipolar Mood Stabilizing Rx

  1. Lithium
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    Side effects: Nausea, vomiting, diarrhea, thirst, slurred speech, muscle weakness, hand tremors, mental confusion, weight gain,

    Severe: hypothyroidism, hypotension, kidney dysfunction, confusion, coma and death secondary to pulmonary complications or circulatory collapse.

    Uses: Mania and depression from bipolar disorder, and schizoaffective disorders.

    • Teach: closeness of therapeutic and toxic blood level.  If have symptoms of toxicity, stop the medication and see the doctor immediately. 
    • Adequate fluid intake daily.  Fluid intake of 1500-3000 cc/day 
    • Diet should include adequate salt (lithium decreases sodium reabsorption in the renal 
    • tubules which can cause sodium depletion. A low sodium intake causes relative 
    • increase in lithium retention which and lead to toxicity).
    • Need periodic monitoring of renal and thyroid functioning.
    • May be weight gain, see nutritionist.
  2. Carbamazepine (Tegretal & Equetro)
    Anticonvulsants used as mood stabilizers.
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    Side effects: Dizziness, vertigo, blurred vision, drowsiness, incoordination, ataxia, confusion, hypertension, sedation, heart failure, hypotension, aggravation of coronary artery disease, abdominal pain, dry mouth, nausea, vomiting, decreased white blood count, Stevens-Johnson syndrome (flu-like symptoms, spreading red rash, skin or mucous membrane blisters), liver problems, dysrhythmias.

    Uses:  Bipolar disorder, schizoaffective disorder, and restless leg syndrome. 

    • Nursing Interventions: Teach patients not to abruptly stop medication but to taper off the medication.
    • May decrease the effectiveness of oral contraceptives
    • Avoid taking alcohol while on medication
    • Do not eat grapefruit or drink grapefruit juice
  3. Valporic acid/ Depakote
    Anticonvulsants used as mood stabilizers.
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    • Uses:  Bipolar disorders, First line for mania, agent of choice for “rapid cyclers”, schizoaffective disorder, rage reactions, and mood instability.
    • Primarily to control rage. 

    • Side effects:  Insomnia, nervousness, somnolence, tremor, headache, dizziness, hypertension, fatigue, blurred vision, abdominal pain, weight gain, possible poor blood clotting, liver problems, Steven-J's (stop taking at first sign of rash).
    • Nursing Interventions: 
    • Monitor liver function tests
    • Avoid drinking alcohol while on medication
    • Teach patients not to abruptly stop medication but to taper off the medication
  4. Lamictal/lamotrigine
    Anticonvulsants used as mood stabilizers.
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    Uses:  Good for “rapid cyclers, not as effective for acute bipolar disorder, no weight gain noted, no blood work needed.

    Side effects:  Dizziness, ataxia, diarrhea, blurred vision, rhinitis, nausea, vomiting, Stevens-Johnson syndrome, liver problems. 

    • Nursing interventions: 
    • Do not stop taking the drug abruptly unless rash.  Taper is safer.
    • Stop the medication immediately at first sign of this!
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    • Female patients should report changes to estrogen-containing oral contraceptives
    • since this alters blood levels of lamictal/lamotigine
  5. Topamax/topiramate
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    • Uses:  Bipolar depression and mania
    • Side effects: Dope-a-max. Others similar to other anticonvulsants. 

    • Nursing interventions:
    • May alter liver enzymes   
    • Discourage alcohol use 
    • Gradually taper patient off rather than abruptly stopping the medication
    • Drug may decrease the effectiveness of hormonal contraceptives
  6. Abilify/aripiprazole (antipsychotic)
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    is now approved for first line treatment of bipolar disorder.

    Side effects: May or may not contribute to type-II diabetes.
Card Set
Bipolar Mood Stabilizing Rx
Mental Health