MOOD STABLIZERS DRUGS.pptx

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 20 th 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. Lithium Anti Convulsant Drugs 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