The document provides an overview of anti-manic drugs used to treat mania and bipolar disorder, detailing their definitions, pharmacodynamics, indications, side effects, and nursing roles in management. It discusses specific medications, particularly lithium, its mechanism of action, and potential toxicities, as well as the action of antipsychotics and anticonvulsants in stabilizing mood and controlling seizures. Monitoring and patient education are emphasized to mitigate risks and ensure effective treatment.

1. Anti Manic Drugs
Under super vision
Dr/Eman Mahmood
Designed By /Ali Abd Al-
kareem
&
Barsoum Ghabrial Fayek

2. Introduction About Mania
Definition
pharmacodynamics & pharmacokinetics
Indications & Contraindications
Side Effects
Drug interaction
Outlines
2

3. Contraindication
Toxicity & management
Health teaching
Nursing Role
Conclusion
Reference
Outlines
3

4. Mania and Bipolar Disorder
Mania
 Mania is a state of heightened energy, euphoria, and
impulsivity, often characterized by racing thoughts, poor
judgment, and risky behaviors.
Bipolar Disorder
 Bipolar disorder is a mental health condition
characterized by alternating periods of mania and
depression.
Treatment Goals
 Anti-manic medications are essential for managing
the symptoms of mania and preventing future
episodes, promoting overall well-being and
improving quality of life.

5. Symptoms and Characteristics of Mania
1 Elevated Mood
 Individuals experiencing
mania often feel overly
happy, euphoric, and
energetic. This can lead to
increased talkativeness,
impulsivity, and a
decreased need for sleep.
2 Racing Thoughts
 Thoughts may come and go
rapidly, making it difficult
to focus or complete tasks.
This can lead to difficulty
concentrating and
disorganized speech.
3 Increased Activity
 People with mania
may engage in
activities with
excessive energy,
such as spending
sprees, impulsive
travel, or risky
behaviors.
4 Grandiose Ideas
 A sense of inflated self-
esteem, believing they
have special abilities or
are destined for
greatness. This can
lead to unrealistic goals
and poor judgment.

6. Causes and Risk Factors of Mania
Genetic Predisposition
 Family history of bipolar
disorder or other mood
disorders significantly
increases the risk of
developing mania.
Environmental Factors
 Stressful life events, such as
major changes, trauma, or
loss, can trigger manic
episodes in individuals with
a predisposition.
Substance Abuse
 Drug and alcohol abuse can
increase the risk of developing
mania and worsen existing
symptoms. This is due to the
effects of substances on brain
chemistry and mood
regulation.
Medications
 Certain medications,
such as corticosteroids
and antidepressants, can
trigger manic episodes
in some individuals.

7. Definition of Anti-Manic Drugs
1 Mood Stabilizers
 These medications work
by balancing the levels of
neurotransmitters in the
brain, particularly
serotonin and dopamine.
2 Reduce Mania
 Anti-manic drugs are
designed to alleviate the
symptoms of manic
episodes, which include
elevated mood, racing
thoughts, and impulsive
behaviors.
3 Prevent Recurrences
 They also play a vital role in preventing future
manic episodes and promoting long-term mood
stability.
 Anti manic drugs, also known as mood stabilizers, are a class of
medications used to treat bipolar disorder and other mood
disorders.

8. What are Anti Manic Drugs?
 Anti manic drugs are medications that help to stabilize mood swings and reduce the severity
of manic episodes.
 They work by influencing the levels of certain neurotransmitters in the brain.
1 Reduce Mania
 They help to lessen the
intensity and duration of
manic episodes.
2 Prevent Recurrence
 They work to prevent
future mood swings and
stabilize mood overall.
3 Manage Symptoms
 They help to manage the
associated symptoms of
mania, such as agitation,
irritability, and sleep
disturbances.

9. Indications for Use
Bipolar Disorder
 Anti-manic medications
are the mainstay
treatment for bipolar
disorder, helping to
manage manic episodes
and prevent future
occurrences.
Schizoaffective Disorder
 In some cases, anti-manic
drugs may be used in
combination with
antipsychotics to manage
the mood symptoms of
schizoaffective disorder.
Other Conditions
 Anti-manic medications may be
used off-label to treat certain
conditions, such as severe
agitation or aggression, but
their use should be carefully
considered and monitored by a
healthcare professional.

10. Criteria for Initiating
Anti-Manic Treatment
 Severe Mania  Presence of
psychosis,
hallucinations, or
delusions
 Risk of harm
to self or
others
 History of Frequent
Episodes
 Previous episodes of
mania that have been
difficult to manage
 High risk of
recurrence
 Functional
Impairment
 Significant disruption
in work,
relationships, or daily
life
 Inability to
perform normal
activities

11. Adverse Effects and Monitoring
1
 Drowsiness and Fatigue
 Some anti-manic drugs can cause drowsiness or fatigue.
Monitor the patient's alertness and adjust activities as
needed.
2  Weight Gain
 Weight gain can be a side effect of some anti-manic
medications. Encourage healthy lifestyle habits and
monitor weight regularly.
3  Tremors
 Tremors are a common side effect of certain anti-manic
drugs. The doctor may adjust the dosage or prescribe
alternative medications if tremors are severe.
4  Blood Tests
 Regular blood tests are necessary to monitor for
potential side effects, such as changes in liver function
or blood cell counts, and to adjust medication dosages
if necessary.

12. Potential Side Effects and
Monitoring
 Anti manic drugs can cause a range of side effects, some of which
can be serious. Regular monitoring is crucial to manage these
potential risks.
5  Weight Gain
Some anti manic drugs may increase appetite and
contribute to weight gain.
6  Drowsiness
Drowsiness is a common side effect, especially
during initial treatment.
7  Tremors
Lithium, for example, can cause tremors in some patients.

13. Mechanism of Action
Neurotransmitter Modulation
 Anti-manic drugs often work by influencing the
activity of neurotransmitters like serotonin,
dopamine, and glutamate, which play a crucial
role in regulating mood and behavior.
Synaptic Transmission
 These drugs may also affect the process of
synaptic transmission, the communication
between neurons, by altering the release,
reuptake, or receptor binding of
neurotransmitters.

14. ‘’Lithium’’
Mechanism of action
 Involves Several Pathways:
 Inhibits The Enzyme Inositol Monophosphatase
This Leads To Decreased Activity Of Neurotransmitters That Are Often Elevated During Man
ic Episodes.
 Inhibition Of Glycogen Synthase Kinase:
These Actions Help Stabilize Mood And Reduce The Severity Of Manic Symptoms.
 Lithium is a mood stabilizer commonly used to treat bipolar disorder, including manic episodes.

15. Adverse effects
 Common adverse effects of lithium include
nausea, headache, diarrhea , vomiting , Tremore and Weight gain
 When concentration of lithium in serum increases to 1.5 mmol/L, toxicity may be induced. This leads to :
loss of coordination, drowsiness, weakness, slurred speech and blurred vision.
 When concentration of lithium in serum increases to 2 mmol/L, this may lead to:
chaotic cardiac rhythm and brain-wave activity with seizures
 Prolonged use of lithium may damage the body's ability to respond properly to hormone vasopressin
(ADH) (stimulates water reabsorption) This gives rise to diabetes insipidus, a disorder characterized by
polyuria and polydipsia.

16. Lithium toxicity can occur when there's too much lithium in the blood, and it can be
quite serious.
Causes: Lithium toxicity can result from excessive intake, decreased excretion (due
to dehydration, low sodium diet, or kidney problems), or interactions with other
medications like NSAIDs.
 Level 1
 Serum level 1.5 to 2
 Symptoms:
 blurred vision, ataxia, persistent nausea and vomiting
Level of Toxicity lithium

17. Level of Toxicity lithium
Management: It's crucial to monitor blood levels regularly and stay hydrated. In cases of severe
toxicity, medical intervention is necessary to stabilize the patient and reduce lithium levels.
 Regular monitoring and communication with a healthcare provider are essential to prevent and
manage lithium toxicity
 Level 2
Serum Level 2 to 3.5
Excessive output of dilute Urine, increased Tremors, muscular irritability, Mental
Confusion
 Level 3
At Serum Level above 3.5
 Impaired Consciousness, Seizures, Coma, oliguria, Anuria, Arrhythmia,
myocardial infarction lead to death

18. 1. Monitor older adults carefully to prevent toxicity as they
may not tolerate the toxicity.
2. Monitor timely the occurrence of hypothyroidism.
3. Weight the patient daily.
4. Check ankles, tibiae, and wrists for edema.
5. Maintain input-output chart.
6. Report early signs of extrapyramidal reactions promptly to
physician.
Nursing Role Lithium Carbonate

19. Lithium is used to treat and prevent manic episodes in bipolar disorder. It helps stabilize mood and reduce the
severity of manic symptoms.
 Dosage and Administration: It's crucial to take lithium exactly as prescribed by the healthcare provider.
 Skipping doses or stopping the medication abruptly can lead to relapse or withdrawal symptoms.
 Monitoring: Patients need regular blood tests to monitor lithium levels and kidney function. This helps prevent
toxicity and ensures the medication is at a therapeutic level.
 Side Effects: Educate patients about common side effects like nausea, diarrhea, tremors, and dry mouth, as well
as more severe side effects like lithium toxicity.
 Encourage them to report any unusual symptoms to their healthcare provider immediately.
 Lifestyle Adjustments: Advise patients to maintain a consistent salt intake and stay well-hydrated, as changes in
sodium levels and dehydration can affect lithium levels in the body.
 Avoiding Interactions: Warn patients about potential interactions with other medications, especially NSAIDs,
diuretics, and certain antibiotics, which can increase the risk of toxicity.
 Emergency Information: Provide information on what to do in case of an overdose or severe side effects,
including emergency contact numbers and the importance of seeking immediate medical attention. By
providing comprehensive health education, patients can better manage their condition and reduce the risk of
complications
Health Education for Lithium as an Antimanic Drug

20. Antipsychotics
 Antipsychotics Also Known As: Neuroleptics or Major Tranquilizers Antipsychotics are a class of
medications primarily used to treat psychosis, which includes symptoms like delusions,
hallucinations, and disordered thinking.
 They are commonly prescribed for conditions such as schizophrenia, bipolar disorder, and severe
depression.
 There are two main types of antipsychotics :
Typical (First-Generation) Antipsychotics Atypical (Second-Generation)
Antipsychotics
These older medications are effective but
often have more severe side effects, such
as tardive dyskinesia (involuntary
movements).
These newer medications tend to have
fewer side effects and are often preferred
for long-term treatment .
Common examples of antipsychotics
include risperidone, olanzapine, and
quetiapine

21. Mechanism of action
 The mechanism of action of antipsychotics primarily
involves blocking dopamine receptors in the brain
 Dopamine is a neurotransmitter that plays a key role in
the transmission of signals in the brain, and its
overactivity is associated with symptoms of psychosis,
such as delusions and hallucinations
 Antipsychotics work by blocking dopamine receptors
(mainly D2, D3, and D4 subtypes) which helps to
reduce these symptoms
 This is why they are effective in treating conditions like
schizophrenia, bipolar disorder, and severe depression

22. Adverse effects
Antipsychotics can have a range of side effects.
 Some common side effects include:
1. Weight gain
2. Drowsiness
3. Dry mouth
4. Blurred vision
5. Constipation
6. Dizziness
7. Restlessness (akathisia)Muscle stiffness (extrapyramidal symptoms)
 More serious side effects can include:
Tardive dyskinesia: Involuntary movements, often of the face and tongue.
Metabolic syndrome: Increased risk of diabetes, high cholesterol, and high blood pressure.

23.  Perform all baseline tests including platelet count,
bleeding time.
 Monitor keenly client during the dose adjustment and
monitor the client for any adverse reactions.
 Multiple drugs for seizure control increase the risk of
hyperammonemia, marked by lethargy, anorexia,
asterixis, increased seizure frequency, and vomiting.
Report such symptoms promptly to physician. If they
persist with decreased dosage, the drug will be
discontinued.
 Do not discontinue therapy abruptly, firstly discuss with
Consult physician before you stop or alter dosage
regimen because this may lead to loss control over
seizures
Nursing Role

24. Anticonvulsants
 Anticonvulsants work through several mechanisms to stabilize neuronal activity and
prevent seizures. Seizures occur due to abnormal and excessive electrical activity in the
brain, and anticonvulsants aim to reduce this by influencing neurotransmitters, ion
channels, and synaptic transmission. Different anticonvulsants use various mechanisms to
achieve seizure control. Here's an overview of the primary mechanisms of action:
 1. Sodium Channel Inhibition
Several anticonvulsants block voltage-gated sodium channels in neurons, stabilizing the inactive
state of these channels and preventing repetitive firing of action potentials. This limits the spread
of seizure activity.
Mechanism: By binding to sodium channels, these drugs prolong the inactivation phase, reducing
the excitability of neurons and inhibiting the propagation of seizure activity
Mechanism

25. 3. Enhancement of GABAergic Activity
Gamma-aminobutyric acid (GABA) is the main inhibitory neurotransmitter in the brain. By enhancing
GABA activity, anticonvulsants increase inhibitory effects, reducing neuronal excitability.
Mechanism:
•Benzodiazepines and barbiturates enhance the effect of GABA on GABA-A receptors, increasing
chloride ion influx, which hyperpolarizes the neuron, making it less likely to fire.
•Gabapentin increases GABA release.
•Tiagabine inhibits GABA reuptake, prolonging its inhibitory effects.
Anticonvulsants Mechanism ,con
2. Calcium Channel Inhibition
Certain anticonvulsants inhibit T-type calcium channels, which play a role in controlling rhythmic
bursts of neuronal firing, particularly in absence (petit mal) seizures.
Mechanism: Blocking these calcium channels reduces the neuronal pacemaker activity responsible
for generating abnormal electrical discharges in specific types of seizures.

26. 6. Multiple Mechanisms
Some anticonvulsants work through a combination of mechanisms, making them effective across a broad spectrum
of seizure types.
5. Inhibition of Synaptic Vesicle Proteins (SV2A)
Some anticonvulsants act by binding to synaptic vesicle proteins, such as SV2A, which are involved in
neurotransmitter release.
Mechanism: Levetiracetam binds to SV2A, modulating neurotransmitter release and preventing the synchronization
of neuronal firing that leads to seizures.
4. Glutamate Inhibition
Glutamate is the major excitatory neurotransmitter in the brain. Some anticonvulsants work by inhibiting glutamate
receptors or decreasing glutamate release, thereby reducing excitatory transmission.
Mechanism:
•Topiramate blocks kainate and AMPA receptors, which are subtypes of glutamate receptors, reducing excitatory
synaptic transmission.
•Lamotrigine inhibits the release of glutamate, limiting excitatory activity.
Anticonvulsants Mechanism ,con

27. Adverse effects
Anticonvulsants can cause various adverse effects, ranging from mild to severe. Here’s a summary of
common and serious side effects for major anticonvulsants:
1.Phenytoin:
1. Common: Drowsiness, gum overgrowth, nausea.
2. Serious: Liver toxicity, Stevens-Johnson syndrome, arrhythmias.
2.Valproic Acid:
1. Common: Weight gain, tremors.
2. Serious: Liver failure, pancreatitis, hyperammonemia, birth defects.
3.Carbamazepine:
1. Common: Dizziness, blurred vision.
2. Serious: Aplastic anemia, Stevens-Johnson syndrome.
4.Lamotrigine:
1. Common: Dizziness, headache.
2. Serious: Stevens-Johnson syndrome, meningitis.

28. 1.Levetiracetam:
1.Common: Drowsiness, irritability.
2.Serious: Psychosis (rare).
2.Topiramate:
1.Common: Cognitive impairment, weight loss.
2.Serious: Kidney stones, metabolic acidosis, birth defects.
3.Gabapentin & Pregabalin:
1.Common: Drowsiness, dizziness, edema.
2.Serious: Respiratory depression, suicidal thoughts.
4.Benzodiazepines:
1.Common: Drowsiness, confusion.
2.Serious: Respiratory depression, dependence.
5.Phenobarbital:
1.Common: Lethargy, depression.
2.Serious: Respiratory depression, skin reactions.
6.Ethosuximide:
1.Common: Nausea, dizziness.
2.Serious: Bone marrow suppression, skin reactions.
Adverse effects

29. Nursing Role
• Monitor vital signs timely.
• Document and monitor input -output chart of the patient.
• Get all the baseline tests done on periodic basis like CBC, serum
electrolytes, LFT, BUN etc.
• Monitor for the reactions after the drug is given like drowsiness,
dizziness, light-headedness, ataxia, gastric upset.
• Withhold the drug and notify the physician if you notice any of
changes like:
RBC <4 million/mm, Hct<32%, Hgb <11 g/dL,
WBC <4000/mm3, platelet count <100,000/mm3, reticulocyte count
<20,000/mm3, serum iron >150 mg/dL.
• Monitor lithium toxicity.
Anticonvulsants
Carbamazepine

30. Nursing Role
A. Monitor for any development of rashes and stop the
drug immediately.
B. Monitor the plasma levels of lamotrigine when given
with any another drug.
C. Also check for any adverse reaction
D. when lamotrigine is used with other anticonvulsants,
especially valproic acid.
E. Be aware of drug interactions and closely monitor when
interacting drugs are added or discontinued.
Anticonvulsants
Lamotrigine

31. Toxicity & Management
 Phenytoin Toxicity:
•Symptoms: Nystagmus, confusion, coma.
•Management: Reduce or stop the dose, monitor
drug levels, provide supportive care.
 Valproic Acid Toxicity:
•Symptoms: Confusion, liver problems,
hyperammonemia.
•Management: Reduce the dose, use L-carnitine,
monitor liver function.
 Carbamazepine Toxicity:
•Symptoms: Dizziness, ataxia, hyponatremia.
•Management: Discontinue the drug, use
activated charcoal, dialysis in severe cases.
 Lamotrigine Toxicity:
•Symptoms: Dizziness, severe skin rash.
•Management: Immediately stop the drug,
supportive care, corticosteroids if needed.
 Levetiracetam Toxicity:
•Symptoms: Drowsiness, agitation, severe
respiratory depression.
•Management: Supportive care.
 Benzodiazepine Toxicity:
•Symptoms: Drowsiness, respiratory depression,
coma.
•Management: Use flumazenil cautiously,

32. Contraindications and Precautions
Pregnancy
 Some anti-manic
medications may pose
risks to the developing
fetus. Carefully weigh
the potential benefits
and risks before
initiating treatment.
Liver Disease
 Individuals with liver
disease may be more
sensitive to the effects
of certain anti-manic
drugs and may require
dose adjustments or
close monitoring.
Kidney Disease
 Kidney disease can impact the
elimination of anti-manic
medications, leading to potential
drug accumulation and side
effects. Close monitoring and dose
adjustments may be necessary.
Allergies
 Individuals with known
allergies to specific
anti-manic medications
should avoid those
drugs.

33. Health Education and Adherence
1 Medication
Information
 Ensure the patient
understands the purpose,
dosage, and potential side
effects of their medication.
2 Adherence
 Encourage the patient to
take their medication as
prescribed, even if they feel
well. This helps to prevent
relapse and maintain mood
stability.
3 Lifestyle Changes
 Discuss lifestyle modifications,
such as regular exercise, a
healthy diet, and stress
management techniques, which
can complement medication and
contribute to overall well-being.

34. Importance of Adherence and Lifestyle Changes
 Adherence to medication regimens is essential for managing bipolar disorder and maintaining long-term
stability. Lifestyle changes can also play a vital role in mood management.
Exercise
 Regular physical activity can
help improve mood and reduce
stress.
Stress Management
 Techniques like mindfulness,
yoga, and deep breathing can
help reduce stress levels.
Healthy Diet
 Eating a balanced diet can
contribute to overall well-being
and mood stability.

35. Considerations for Special Populations
Elderly
 Older adults may be more sensitive to the side
effects of anti-manic medications and may require
lower doses or more frequent monitoring.
Pregnancy
 Anti-manic medication use during pregnancy should
be carefully considered due to potential risks to the
fetus. Consult a healthcare professional to weigh the
benefits and risks.

36. Considerations in Prescribing
Anti Manic Drugs
 There are several factors to consider when prescribing anti
manic drugs, including the patient's individual medical
history, any other medications they are taking, and their
preferences.
Medical History
• Past medical conditions and allergies must be considered.
Drug Interactions
 Potential interactions with other medications are important to note.
Individual Response
 Each person may respond differently to medication.

37.  Antimanic drugs are psychotropic drugs that are used to treat symptoms of mania. Though
there are different causes of mania, the majority is caused by bipolar disorder
therefore, antimanic drugs are mostly like drugs treating bipolar disorder
 One purpose of antimanic drugs is to alleviate or shorten the duration of an acute mania.
Another objective is to prevent further cycles of mania and maintain the improvement achieved
during the acute episode. The mechanism of antimanic drugs has not yet been fully known,
 it is proposed that they mostly affect chemical neurotransmitters in the brain. However, the
usage of antimanic drugs should be consulted with a doctor or pharmacist due to their side
effects and interactions with other drugs and food
Conclusion

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