ANTIMANIC DRUGS.ppt
-
Upload
tiffany-jane-ng -
Category
Documents
-
view
591 -
download
20
description
Transcript of ANTIMANIC DRUGS.ppt
ANTIMANIC DRUGS
Mood stabilizers
TREATMENT GOALS FOR BIPOLAR DISORDER
• Remission• Prevention• Return to premorbid function
SIGNS AND SYMPTOMS OF BIPOLAR DISORDER – MANIA
Elevated moodIncreased in activitiesFlight of ideasRacing thoughtsInflated self-esteemDecreased need for sleepAgitationMore talkative than is usualPacing, hand wringling
Extreme restlessnessLoses temper oftenSignificant irresponsible behaviorIncreased goal-directed activities (sexual, social)Impaired excessive, involvement in pleasureable activities, with high potential for painful consequencesDelusions
LITHIUM
• Used to treat bipolar disorder by stabilizing the client’s mood, preventing or minimizing the highs and lows that characterize bipolar illness
Mechanism of action
• Inhibits the release of norepinephrine, serotonin, and dopamine while facilitating their reuptake into presynaptic terminals
Therapeutic drug serum level: 0.6 – 1.2 mEq/L
• Serum lithium levels should be checked every 1 – 2 months or whenever any behavioral change suggests an altered serum level• Blood samples to check serum lithium levels should be drawn in the morning, 12 hours after the last dose was taken
CLIENT TEACHING
• Administer medication with food – minimize GI irritation
• Instruct client to maintain fluid intake of 6 – 8 glasses of water a day
• Instruct client to avoid excessive amounts of coffee, tea or cola
• Instruct client to maintain adequate salt intake
• Do not administer diuretics while the client is taking lithium
• Avoid alcohol• Avoid OTC• Client may take a missed dose within 2 hours
of the scheduled time; otherwise, the client should skip the missed dose and take the next dose at the scheduled time
CLIENT TEACHING
• Do not adjust the dosage without consulting the physician – lithium should be tapered off and not discontinue abruptly
• Instruct signs and symptoms of lithium toxicity• Notify physician if polyuria, prolonged
vomiting, diarrhea or fever occur
CLIENT TEACHING
• Therapeutic response to the medication will be noted 1 – 3 weeks
• Monitor electrocardiogram, renal function tests, and thyroid tests
CLIENT TEACHING
Lithium Toxicity• Occurs when ingested lithium cannot be
detoxified and excreted by the kidneys• Serum lithium level : 1.5 mEq/L and
above
Therapeutic Serum Levels (0.6 -1.2 mEq/L)
Mild to Moderate Toxicity (1.5 – 2 mEq/L
Moderate to Severe Toxicity (2 – 3 mEq/L)
Severe Toxicity (>3mEq/L)
Hand tremor (fine)Memory problemsGoiterHypothyroidismMild diarrheaAnorexiaNauseaWeight gainPolydipsia, polyuria
DiarrheaVomitingDrowsinessDizzinessHand tremor (coarse)Muscular weaknessLack of coordinationDry mouth
Previous symptoms and:GiddinessTinnitusBlurred visionLarge output of dilute urineDeliriumNystagmus
Previous symptoms and:SeizuresOrgan failureRenal failureComaDeath
Interventions:
–Hold lithium and notify physician–NO ANTIDOTE is available–Monitor V/s and LOC–Monitor cardiac status
–Prepare to obtain lithium level; electrolytes, BUN, creatinine level and CBC–Gastric lavage–Parental normal saline–Forced dieresis or hemodialysis
Interventions:
INTERACTIONS
Can elevate lithium serum levels
• Diuretics (except acetazolamide)• NSAIDs• Low salt diet after treatment
commences
Can decrease serum lithium levels
–Acetazolaminde (Diamox)–Caffeine–Alcohol
ANTICONVULSANTS
Valproates
• Used as an antiepilectic agent• Increase in the inhibitory role of
GABA• Suppression of sodium influx into
the neuron• Suppression of calcium influx
through specific calcium channels
–Advantages:•Have a rapid onset•Can be used initially without
attempting lithium and are well-tolerated with little effect on cognition
–Disadvantages:• Transient hair loss•Weight gain• Tremors•GI upset•Dose-related thrombocytopenia
Carbamazepine–Effective for most patients who do not
respond to lithium or to the valproates–Has a faster onset of action compared
with lithium
–Side effects:•Nausea•Anorexia•Occational vomiting• Sedation and drowsiness•Agranulocytosis – most serious
potential side effect
Lamotrigine• Approved for the treatment of bipolar disorder
including bipolar depression
• manipulating the GABA system, thus inhibiting neuronal firing• blocking of voltage-gated sodium and calcium
channels, further inhibiting neuronal conduction• believed to inhibit the excitatory neurotransmitter
glutamate
Oxcarbazepine
–Does not cause some of the more serious adverse reactions associated withcarbamazepine–Commonly prescribed agent for
bipolar disorder
Gabapentin
–Tends to be used in an adjunctive role and not as monotherapy–It is believed to be particularly
effective if the patient also experiences anxiety
Topiramate
• It increases GABA activity, blocks voltage-gated sodium and calcium channels, and inhibits the excitatiryneurotransmitter glutamate
ANTIPSYCHOTICS
• Olanzapine• Risperidone• Quetiapine• Ziprasidone• Clozapine• Aripiprazole