Mood Stabilizers

• Mood stabilizers aka anti mania
• First line mood stabilizer - Lithium
• Lethal is >3 meq/L (needs hemodialysis)

  Indicated for Bipolar disorders

  Therapeutic range: 0.6 to 1.2 mEq/L

  Hyponatremia = Toxicity

  Increase excretion with Mannitol (antidote)

  Uncoordination and coarse hand tremors (early signs of toxicity)

  Metallic tase and fine hand tremors (normal side effects)
• Lithium

  Common side effects

  • Earliest - fine hand tremors
  • Decrease appetite due to metallic taste in the mouth
  • Metallic taste in the mouth causes polydipsia
  • Polydipsia cause polyuria
  • Polydipsia causes edema which causes weight gain
• WOF Signs of Lithium Toxicity - mnemonic: VANDA
• WOF Signs of Lithium Toxicity

  • Vomiting
  • Anorexia
  • Nystagmus + visual disturbances
  • Diarrhea or dehydration
  • Abdominal muscle cramps
• Other mood stabilizers:

  • Carbamazepine
  • Valproic acid
• Check serum lithium level before initial dose and after 12 hours of initial dose!
• NURSING MANAGEMENT - LITHIUM

  1. Take with meals to minimize nause
  2. Diuretics enhances lithium effects
  3. Sodium decreases lithium effect
  4. 3 grams of salt daily
  5. High sodium = low drug effect
  6. Low sodium = high SE
• Mood stabilizers - MOA

  Stabilizes reuptake of serotonin, NE, acetylcholine, and dopamine
• NURSING ALERT

  • Valproic acid is hepatotoxic
  • Carbamazepine can cause aplastic anemia and agranulocytosis
  • Lamotrigine can cause Steven-Johnsons Syndrome