Download to read offline
Ppt.pptmood stabilizers of nurse in the
- 2.
- 3. Introduction • These drugsare usually effective in treatment of mania and there the word antimanic is often used to describe them. • As these drugs are effective to manage mood swings in bipolar disorder, the better term is mood- stabilizing agent • The most commonly used mood stabilizing agents include lithium, valproate, carbamazepine and lamotrigine, though there are several other experimental mood stabilizers such as oxacarbazepine.
- 4. Definition • Antimanic drugor Mood Stabiliser is a psychiatric pharmaceutical drug used to treat mood disorders characterized by intense and sustained mood shifts, typically bipolar type I and type II.
- 5.
- 6. Lithium • Lithium isan element (Atomic number 3 and Atomic weight 7) which is the smallest alkali ion. • The element was discovered in 1817 by Arfuedson. • Since then, it has been used for treatment of gout and for salt replacement in cardiac disease, but its use was restricted due to fatal toxicity.
- 7. Contd… • It wasrediscovered in 1949 by John Cade, for use in treatment of mania but its potential went unrecognized as it was discovered in Australia, • Mogen Schou in 1957 had to rediscover it yet again before it became popular as a treatment of mania
- 8.
- 9. Contra- indications During pregnancy and lactationBlood Dyscrasias Concominant medications Dehydration History of seizures Hypothyroidism
- 10. Pharmacokinetics • Lithium isvery rapidly absorbed from the gastrointestinal tract. • The peak serum levels occur between 30 minutes to 3 hours. The absorption is virtually complete in about 8 hours. • The maximum levels occur in thyroid (3-5 times serum level), saliva (two times), milk (0.3-1.0 times) and CSF (0.4 times). .
- 11. Contd… • The steadystate levels are achieved in about 7 days. • There is no metabolism of lithium in body and it is excreted almost entirely by the kidneys
- 12.
- 13. Contd… • It stabilizesthe cell membrane, along with Ca++ and Mg++. • It decreases the Ca++ mobilisation from the intracellular pools by ITP ( inositol-triphos phate)- dependent Ca++ channels (II messenger system). • It interferes with the phosphatidyl-inositol cycle by blocking the conversion of IMP (inositol monophosphate) to inositol, by inositol monophosphate phosphatase.
- 14. Clinical use Lithium carbonate Lithium citrate 300 mg tablets;400 mg sustained-release tablets 300 mg/5 ml liquid
- 15. Blood Lithium Levels •Therapeutic levels = 0.6-1.2 mEq/L • Prophylactic levels = 0.6-1.0 mEq/L • Toxic lithium levels > 2.0 mEq/L
- 16.
- 17. Neurological • Tremor • Muscularweakness. • Cogwheel rigidity (mild). • Seizures (decreased threshold). • Neurotoxicity
- 18. Renal • Polyuria, polydipsia. •Tubular changes. • Nephrogenic diabetes insipidus. • Nephrotic syndrome
- 19. Cardiovascular The effects onheart are similar to those of hypokalaemia. The commonest ECG change is T- wave depression
- 20. Endocrine • Goiter. • Hypothyroidism. •Abnormal thyroid function • Weight gain
- 21.
- 22. Dermatological • Acneiform eruptions’ •Papular eruptions • Exacerbation of psoriasis. During pregnancy and lactation • Teratogenic (possibly). • Increased incidence of Ebstein’s anomaly. • Secreted in milk with 30- 100% of the maternal blood lithium levels.
- 23. Management of lithiumtoxicity • Discontinue the drug immediately. • For significant short term indigestions, residual gastric content should be removed by induction of emesis, gastric lavage and adsorption with activated charchol. • If possible instruct the patient to ingest fluids.
- 24. Contd… • Assess serumlithium levels, serum electrolytes, renal functions, ECG as soon as possible. • Maintenance of fluid and electrolyte imbalance. • In a patient with serious manifestations of lithium toxicity, hemodialysis should be initiated.
- 25. Nurse’s responsibilities fora patient receiving Lithium • The pre lithium work up: • Routine general and systemic physical examination. • Routine blood counts (Hb, TC, DC). • Urine: routine and microscopic examination. • ECG. • Renal function tests • Thyroid function tests
- 26. Health advices tobe given • Lithium must be taken on a regular basis, preferably at the same time daily. • When lithium therapy is initiated, mild side effects may develop. Most of the are transient and do not represent lithium toxicity. • Serious side effects of lithium that necessitate its discontinuance include vomiting, extreme hand tremors, sedation, muscle weakness and vertigo. The psychiatrist should be notified immediately if one of these effects occur.
- 27. Contd… • Not todrive or operate dangerous machinery until lithium levels are stabilized. • Not skimp on dietery sodium intake. He or she should eat a variety of health foods and avoid junk foods. • The client should drink 6 to 8 large glasses of water each day and avoid excessive use of beverages containing caffieine (coffee, tea, colas), which promotes increased urine outfit. • Carry card or other identification noting that he or she is taking lithium.
- 28. Contd… • During treatmentit is essential to estimate blood lithium levels at regular intervals (usually 3 monthly). • The blood sample for estimation is taken 12 hours after the last lithium dose. • If any changes are made in lithium dosage, the next blood level is estimated after at least 5-7 days of the last change.
- 29. Contd.. • The patientshould be told about the importance of regular follow up. In every six months, blood sample should be taken for estimation of electrolytes, urea, creatinine, a full blood count and thyroid function test.
- 30. To avoid teratogeniceffect • Be aware of risks of becoming pregnant while receiving lithium therapy. • Use information furnished by health care providers regarding methods of contraception. • Notify the physician as soon as possible if pregnancy is suspected or planned.
- 31. Valproate • Valproic acidwas first synthesized by Burton and used as an organic solvent. • In 1963, Meunier serendipitously discovered the antiepileptic properties of valproic acid, while Lambert reported in 1966 that valpromide (a valproic acid analogue) might be effective as an antimanic. • It was approved by the US FDA as an antiepileptic drug for absence seizures in 1978 and for the treatment of acute mania (and for migraine headache prophylaxis) in 1996.
- 32. Mechanism of action •By interfering with calcium channels and sodium channels, valproate is thought both to enhance the inhibitory actions of gamma aminobutyric acid (GABA) and to reduce the excitatory actions of glutamate.
- 33.
- 34. Indications • Co-morbid substanceabuse or other psychiatric disorders. • Later age at onset and/or shorter duration of illness • History of poor response to lithium • Dysphoric mania, mixed affective episodes, or rapid cycling • Organic/complicated mania associated with seizure disorder, history of head trauma, or EEG abnormalities • D-M-I (Depression-Mania-Well Interval) pattern of illness, as opposed to the M-D-I pattern
- 35. Contd… • Rapid cyclingbipolar disorder and mixed (or dysphoric) mania • Bipolar depression • Migraine and Pain syndromes • Seizure disorders • mental retardation
- 36.
- 37. Nurse’s Responsibilities • Advisethe patient to take the drug immediately after food to reduce GI irritation. • Advise regular follow up and periodic examination of blood count, hepatic function and thyroid function. • Refrain from discontinuing the drug abruptly, physician will administer orders for tapering the drug when therapy is to be discontinued.
- 38. Contd… • Report thefollowing symptoms to the physician immediately: skin rash, unusual bleeding, spontaneous bruising, sore throat, fever, malaise, dark urine and yellow skin or eyes. • Do not drive or operate dangerous machinery until reaction to the medication has been established. • Avoid consuming alcoholic beverages and non- prescription medications without approval from physician. • Carry card at all times identifying the name of medication being taken.
- 39. Carbamazepine • It isa tricyclic compound synthesized in 1953 by Schindler. • Pharmacokinetics: The onset of action can be faster as compared to lithium, but slower compared to valproate. • Dosage: The usual dose is 600-1600 mg/day orally, in divided doses. The treatment is best monitored with repeated blood level. The therapeutic blood levels are 4-12 μg/ml and the toxic blood levels are usually reached at >15 μg/ml. •
- 40. Mechanism of action •By interfering with sodium and potassium, carbamazepine is thought to enhance the inhibitory actions of gamma aminobutyric acid (GABA).
- 41.
- 42. Side effects • Diplopia •Drowsiness • Dizziness • Nausea • Vomiting • Ataxia • Skin rash • Steven-johnson syndrome • Photosensitivity • Cholestatic jaundice • Acute oliguria with hypertension • Leucopenia • Thrombocytopenic purpura. • Bone marrow depression • Agranulocytosis • Cardiovascular collapse.
- 43. Nurse’s responsibility • Sincethe drug may cause dizziness and drowsiness advise him to avoid driving and other activities requiring alertness. • Advise patient not to consume alcohol when it is on the drug. • Emphasize the importance of regular follow up visits and periodic examination of blood count and monitoring of cardiac renal, hepatic and bone marrow functions.
- 44.
- 45.
- 46. Assignment • Write Nursingcare plan for a patient with Antimanic drug(Lithium).
- 47. Conclusion • Having groupedlithium, valproate and carmazepine together, it is important to note they have subtle differences in their therapeutic profiles and differential predictors of response. Response to one of these agents is not predictive of either a positive or negative response to the others.