MOOD STABLIZER DRUGS WITH NURSES RESPONCIBILITY

1. MOOD STABLIZER
OR
ANTI MANIC DRUGS
MS.POOJA SEN
NURSING LECTURER

2. INTRODUCTION
• It is also know as a mood stablizer,this drug used to
treat mood disorder. This is diverse group of drug used
primarily of bipolar disorder and other condition related
to thematically through the presence of mood
abnormality .

3. HISTORY
• 1817- Lithium was discovered as a chemical element.
• 1871- First recorded use as a treatment of mania.
• By the beginning of 20th use of lithium was abandoned due to its
toxicity.
• 1949- use of lithium for mania rediscovered by JOHN CADE.
• 1970 – FDA approved use of lithium for mania.
• 1995- sodium valproate approved for acute type of mania.

4. DEFINITION
Any medication that is able to decrease vulnerability to
subsequent episodes of mania or depression and not
exacerbate the current episode od maintains phase of
treatment.
Mood stabilizer is a drugs which is used for treatment of
bipolar affective disorders.

5. CLASSIFICATION
There is no any specific classification of mood stabilizer
but we can classify the mood stabilizers in 3 categories.
1. Lithium
2. Anti Convulsant Drugs
3. Anti psychotic Drugs

6. 1. LITHIUM
Lithium is a element with the atomic number 3 and atomic
weight 7. It was discovered by FJ CADE in 1949 and is a
most effective and commonly used drug in the treatment of
mania.
Lithium has been used for over years.

7. 1. LITHIUM
Lithium Classification- Lithium carbonate, Lithium chloride
DOSE -
Adult – 900-1800 mg/day
Children 15-20 mg/day
Starting from 300 mg/day

8. LITHIUM
MECHANISM OF ACTION
• Accelerate presynaptic re-uptake & destructions of
catecholamine like norepinephrine
• Inhibit the release of catecholamines at the synapses.
• Decreases the post synaptic serotonin receptors.

9. INDICATION
• Acute mania
• Schizoaffective Disorder
• Cyclothymia
• Impulsivity or aggression
• Bulimia Nervosa
• Bipolar Disorder
• Borderline personality disorder
• Trichotillomania
• Cluster headaches
• Pre menstrual dysphoric
disorder
• Severe alcoholism

10. CONTRA INDICATION
• Cardiac, renal, thyroid or neurological dysfunction
• During first trimester of pregnancy & lactation
• Severe dehydration (because it inhibit the reabsorption
of water leading excessive urination & thirst )

11. PHARMACOKINETICS
Lithium is readily absorbed with peak plasma level occurring 2-4
hours after a single oral dose of lithium carbonate, lithium is
distributed rapidly in liver & kidney and more slowly in muscles,
brain and bone. Elimination occur through kidney. Lithium is
reabsorbed in the proximal tubules and its influenced by sodium
balance. Depletion of sodium can cause lithium toxicity.

12. SIDE EFFECT
• Neurological – Tremors, Motor hyper activity , muscles weakness ,
seizure
• Renal(due to blocking od ADH) – Polydipsia (the condition
abnormal thirst) Polyuria ( an abnormal large output of urine,
Nephrotic syndrome
• G I – Nausea, Vomiting , Diarrhea, Abdominal pain, Metallic taste

13. SIDE EFFECT
• Endocrine – Abnormal thyroid function, Goiter ,wight gain
• During Pregnancy & Lactation – Teratogenic Possibility,
incidence of Ebstein's Anomaly ( distortion and downward
displacement of tricuspid valve in right ventricles)
• Secreted through milk and can cause toxicity in child.

14. LITHIUM TOXICITY
• First lithium toxicity was discover by 1898.
• Name originated from LITHOS means stone.
• It discover through minerals.
• Use of lithium firstly used in 1949 by Australian doctor for
the treatment of mania.

15. Blood lithium level
• Therapeutic level – 0.8 – 1.2 meq/L
• Prophylactic level – 0.6 – 1.2 meq/L
• Toxic level - 2 meq/L

16. Toxicity occurs when the serum lithium level is -
More than 2 meq/L
STAGES –
 Acute Toxicity – acute toxicity occurs when you swallow too much of lithium
prescription at one time.
Symptoms- diarrhea, dizziness, nausea, weakness, pain ,vomiting ,
 Chronic Toxicity – chronic toxicity occur when you take a little too much
lithium prescription every day for while, this usually actually quite easy to do ,
because dehydration , other condition or how your body handles the lithium.
Symptoms- tremor, kidney failure, memory problems, movement problems.

17. Sign & symptoms of
lithium toxicity
• Nephrotoxicity
• Muscles weakness
• Convulsion
• Dysarthria (difficulty in speaking)
• Lethargy
• Confusion
• Coma
• Nystagmus (involuntary eye movement)
• Ataxia ( loss of control of
body movement)
• Coarse tremor(hand) an
involuntary trembling of the
body or limbs.
• Nausea & Vomiting
• Impaired memory
• Impaired concentration

18. Management of Lithium Toxicity
• Discontinue the drug immediately.
• For significant short term ingestions residual gastric content
should be removed by induction of emesis, gastric lavage.
• Assess serum lithium level and ECG as soon as possible.
• Maintain fluid and electrolyte balance.
• Thyroid function and kidney function test also be done.

19. Management of Lithium Toxicity
• Lithium must be taken on a regular basis preferably at the
same time daily.
• Frequent serum lithium level evaluation is important. Blood
for determination of lithium levels should be drawn in the
morning approximately 12-14 hours after the last dose was
taken.

20. 2. CARBAMAZEPINE
• It is available in market under different trade names like Tegretol, Mazetol,
Zeptol and Retard.
DOSE- 600-1800 Mg Orally, in divided doses ,the therapeutic blood levels are
612 ug/ml. Toxic blood levels are attained at more then 15ug/ml.

21. Its mood stabilizing mechanism is not clearly established its anti convulsant
action my however by decreasing synaptic transmission in the CNS.
MECHANISM OF ACTION

22. • Carbamazepine is a medication used to treat various conditions, including
epilepsy, trigeminal neuralgia, and bipolar disorder.
• Epilepsy: Carbamazepine is effective in controlling focal seizures and
generalized tonic-clonic seizures.
• Trigeminal Neuralgia: It is used to alleviate the intense facial pain associated
with trigeminal neuralgia, a chronic pain condition affecting the trigeminal
nerve.
• Bipolar Disorder: Carbamazepine is prescribed for mood stabilization in
bipolar disorder, helping to prevent manic and depressive episodes.
INDICATION

23. • Rapid cycling bipolar disorder
• Acute depression
• Impulse control
• Aggression
• Psychosis with epilepsy
• Borderline personality disorder
• Cocaine withdrawal syndrome
INDICATION

24. CONTRAINDICATION
• Hypersensitivity to carbamazepine
• History of bone marrow depression
• Pregnancy and lactation
• Glaucoma
• History of cardiac ,renal damage

25. SIDE EFFECT
• Confusion
• Drowsiness
• Headache
• Hypertension
• Jaundice
• Hepatitis
• Dry mouth
• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Ataxia
• Oliguria
• Bone marrow depression

26. NURSES RESPONCIBILITY
• Since the drug may cause dizziness and drowsiness advice him to avoid
driving and other activities requiring alertness.
• Advice patient not to consume alcohol when he is on the drug therapy.
• Emphasize the importance of regular follow up visits and periodic
examination of blood count and monitoring of cardiac, renal, hepatic
and bone marrow functions.

27. 3.SODIUM VALPROATE
• Sodium valproate is an anticonvulsant drug used as a mood
stabilizer.it is also known by the trade names Encorate chrono ,
valparin , exilex , epival , epilim and Depakote.
• DOSE- The usual dose is 15 mg/kg/day with a maximum of 60
mg/kg/day orally.

28. The drug acts on gamma aminobutyric acid GABA an inhibitory amino acid
neurotransmitter. GABA receptors activation servers to reduce neuronal
excitability.
MECHANISM OF ACTION

29. • Acute mania, prophylactic treatment of bipolar
• Schizoaffective disorder
• Seizure
• Other disorder like bulimia nervosa, OCD, PTSD
INDICATION

30. CONTRAINDICATION
Hypersensitivity to valproic acid , hepatic disease
(condition that damages the liver and prevents it from
functioning well.)
use cautiously with children below 2 years , pregnancy
lactation.

31. SIDE EFFECT
• Confusion
• Drowsiness
• Headache
• Wight gain
• Dry mouth
• Tremor
• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Dysarthria

32. NURSES RESPONCIBILITY
• Since the drug may cause dizziness and drowsiness advice him to
avoid driving and other activities requiring alertness.
• Advice patient not to consume alcohol when he is on the drug
therapy.
• Explain the patient to take the drug immediately after food to
reduce GI irritation.
• Advice to come for regular follow up and periodic examination of
blood count ,hepatic function and thyroid function. therapeutic
serum level of valproic acid is 50-100 micrograms /ml.

33. THANK YOU