Anti manic agents
1- Lithium
Class: mood stabilizer
Uses: Bipolar disorder
MOA: specific mode of action is unknown. It alters chemical changes in the brain and
interacts with numbers of neurotransmitters.
Theurapeutic range: 0.6-1.2, toxic at 1.5
Adverse effect: Nephrotoxic, hypothyroidism.
Patient Teaching:
-Normal diet with sodium (do not increase sodium as it can lower lithium level, also do
not decrease as lithium already lower sodium).
-Report any sign of lithium toxicity
-Drink plenty of water to stay hydrated and flush out the lithium. Lithium can get toxic if
dehydrated.
-Never abruptly stop the drug!!
-Interaction: NSAIDS (ibuprofen can damage kidneys and cause lithium toxicity),
diuretics (cause dehydration and lithium toxicity), Tricyclic antidepressant (Amitriptyline
can cause urinary retention)
Lithium toxicity S/S: Tremors, paresthesia, blurred vision, Polyuria, difficulty
speaking
Contraindication: Renal dysfunction, thyroid disorder, pregnancy, seizures, diabetes,
dehydration, heart disease.
Nursing consideration: Monitor lithium level (weekly or more frequently at the
beginning of treatment), monitor sodium level, monitor BUN (Blood Urea Nitrogen) and
creatinine frequently.
2-Valporic Acid:
Class: Anticonvulsant mood stabilizer
Uses: Bipolar disorder and seizure disorders
MOA: inhibit sodium and calcium channels to slow neurons firing and excitability. Also
block glutamate (Decreasing CNS excitation).
Adverse effect: Thrombocytopenia (increases risk of bleeding)
Contraindication: Pregnancy category X (can cause neural tube defect, Liver disease,
Thrombocytopenia.
Patient teaching:
-Report signs of liver toxicity (jaundice, and yellow urine).
-Report for abnormal bleeding of the gum, black tarry stool as it can cause
thrombocytopenia.
-Never abruptly stop the drug!!
Nursing consideration: Monitor liver function periodically, Monitor platelets level
periodically.
3-Carbamazepine
Class: Anticonvulsant mood stabilizer
Uses: Bipolar disorder, seizure disorders and neuropathic pain.
MOA: inhibit sodium and calcium channels to slow neurons firing and excitability. Also
block glutamate (Decreasing CNS excitation)
Adverse effect:
-Leukopenia (increases risk of infection)
Contraindication: Pregnancy category X, Liver disease,
Patient teaching:
- Report fever and sore throat can be due to leukopenia
-Oral contraceptives are ineffective, need alternative mode of contraception.
-Never abruptly stop the drug!!
Contraindication: Pregnancy category X, Liver disease.
Nursing consideration: Monitor liver function labs frequently, Monitor WBC.