Bipolar Mood Stabilizing Rx

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.

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

• 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

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!
• 
• Female patients should report changes to estrogen-containing oral contraceptives
• since this alters blood levels of lamictal/lamotigine

• 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

is now approved for first line treatment of bipolar disorder.

Side effects: May or may not contribute to type-II diabetes.