MOOD
Mood
stabilizers are used in the treatment of mood disorders which elevate depressed
mood and suppresses elevated mood.
a)
Lithium carbonate
b)
Carbamazepine
c)
Sodium valproate
a)
LITHIUM CARBONATE
It was discovered by FJ Cade in 1949, and is a
most effective and commonly used drug in the treatment of mania
Mechanism
of action
·
Lithium ion substitutes sodium in neurons. Body
cannot distinguish lithium and sodium.
·
It accelerate pre synaptic reuptake and
destruction of catecholamines it
inhibits release of catecholamines at synapse
·
Decreases post-synaptic serotonin receptor
sensitivity
·
(all these actions result in decreased catecholamine activity,
thus ameliorating mania)
Pharmacokinetics
·
Absorption- well absorbed by oral
administration.
·
Distribution- evenly distributed to tissues and
body fluids. maximum level in thyroid, saliva, milk, CSF.
·
Metabolism- NOT
METABOLISED, found in body as such.
·
Excretion- kidneys
Dosage
·
900-2100 mg given in 2-3 divided doses
·
ideally, the treatment is starded after lithium
estimation, done after a loading dose of 600 mg or 900 mg of lithium carbonate,
to determine the pharmacokinetics
·
During the treatment, it is essential to
estimate blood lithium levels at regular intervals
·
The blood sample for estimation is taken 12
hours after the last lithium dose
·
Tab. Licab 300 mg
·
Tab. Lithosun-SR 400 mg
·
Lithium citrate: 300mg/5ml liquid
Indication
·
Acute Mania
·
Prophylaxis for bipolar mood disorders
·
Schizoaffective disorder
·
Cyclothymia (mild depression and hypomania,never
reach the severity)
·
Impulsivity and aggression
·
Other disorders: premenstrual dysphoric
disorder, bulimia nervosa, borderline personality disorder, Trichotillomania,
Cluster headaches
Contra
indications
·
Severe renal disorder
·
Cardiovascular disease
·
Severe dehydration
·
Pregnancy and lactation
·
Hypothyroidism
·
History of seizure
Blood
lithium levels
·
Therapeutic levels: 0.6-1.2 mEq/L
·
Prophylactic levels: 0.6-1.0 mEq/L
·
Toxic levels: > 2 mEq/L
Side
effects
1. Neurological:
tremor, muscular weakness, cogwheel rigidity, seizures, neurotoxicity
2. Renal:
polyuria, tubular changes, nephrogenic
diabetes insipidus, nephrotic syndrome
3. Cardiovascular:
T wave depression in ECG
4. Endocrine:
goiter, hypothyroidism, abnormal thyroid function, weight gain
5. GIT:
nausea, vomiting, diarrhoea, metallic taste and abdominal pain
6. Dermatological:
acneiform eruptions, papular eruptions, and exacerbation of psoriasis
7. Pregnancy
and lactation: Ebstein's anomaly, toxicity in the infant
Sign
and symptoms of toxicity:
Ataxia,
coarse tremor, nausea, vomiting, impaired memory, impaired concentration,
nephrotoxicity, muscle weakness, convulsions. muscle twitching, dysarthria,
lethargy, confusion, coma, nystagmus
Management
of toxicity
·
Discontinue the drug immediately
·
No antidote available
·
Gastric lavage
·
Instruct the patient to ingest fluids
·
Assess serum lithium levels, serum electrolytes,
renal functions and ECG as soon as possible
·
Severe poisioning: forced diuresis or
hemodialysis
Nurse's
Responsibility
·
The Pre-Lithium work up: a complete physical
history, ECG, blood studies, urine examination, must be carried out
·
Renal function and thyroid function should be
tested
·
Serious side effects should be notified to the
Psychiatrist immediately
·
Frequent serum lithium level evaluation
·
Take medication on regular basis even when
feeling well.
·
Not to drive dangerous machines , drowsiness and
dizziness can occur
·
Adequate fluid and sodium intake.
·
Notify if vomiting or diarrhea occurs.
·
Be aware of side-effects and symptoms associated
with toxicity
·
The patient shourd be told about the importance
of regular follow up
b)
CARBAMAZEPINE
Used as
a mood stabilizer and anti convulsant
(Tegretol,
Mazetol, Zeptol, Zen Retard)
Dose-
Daily
dose: 600-1800 mg in divided doses
Therapeutic
blood level: 6-12 ug/ml
Toxic
level- > 15ug/ml
Pharmacokinetics
·
Absorption -GIT
·
Distribution -crosses blood brain barrier and
placental barrier.
·
Metabolism -liver
·
Excretion -kidney
Indication-
·
Bipolar affective disorder
·
Seizure disorder
·
Paroxysmal pain syndrome
Contra
indication-
·
Bone marrow suppression
·
Pregnancy and lactation
Side
effects
·
Agranuiocytosis, ChoiesÃatic jaundice
·
Drowsiness, confusion, headache, ataxia,
·
hypertension, arrhythmia.
·
rashes, urticaria, photosensitivity
·
nausea, vomiting, diarrhea, abdominal pain
·
Thrombocytopenic purpura, leucopenia, aplastic
anemia
C)
SODIUM VALPORATE
(Encorate chrono, valparine, Epilex, Epival)
Dosage:
15mg/kg/day-60mg/kg/day
Therapeutic
serum level- 50-100ug/ml
Indication:
acute mania, schizo affective disorder, BPAD, seizures, bulimia nervosa,
compulsive disorder, agitation, PTSD.
Rapid
onset of action, drug acts on GABA, an inhibitory neurotransmitter, this
reduces neuronal excitability
Side
effects: hair loss, weight gain, GI upset, nausea, vomiting, diarrhoea,
sedation, ataxia, dysarthria, tremor, thrombocytopenia, platelet dysfunction
Nurses
role
l.
Advice the patient to take drug immediately after food to avoid GI irritability
2.
Advice regular follow up and periodic examination of blood count, hepatic and
thyroid function
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