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Mood Stabilisers

Mood Stabilisers. By the Mood S wingers Group 1. Indicators for Use of Lithium. Manic depressive Psychoses Schizoaffective illness. Adverse Effects of Lithium. Side effects of lithium include: Nausea & vomiting diarrhoea abdominal pain muscle weakness Thirst polyuria tremor

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Mood Stabilisers

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  1. Mood Stabilisers By the Mood Swingers Group 1

  2. Indicators for Use of Lithium • Manic depressive Psychoses • Schizoaffective illness.

  3. Adverse Effects of Lithium • Side effects of lithium include: • Nausea & vomiting • diarrhoea • abdominal pain • muscle weakness • Thirst • polyuria • tremor • Weight gain • Signs of toxicity include: • ataxia, • muscle twitching • coarse tremor and • muscle weakness. • This may progress to; • drowsiness, • disorientation, • hypertonicity, • hyperreflexia, • fasciculations, • convulsions and coma. • Dementia, focal neurological deficits or death may ensue.

  4. Contraindications/ Precautions • Toxicity may develop because of: • excessive intake • dehydration and poor salt intake • renal impairment • deliberate over-dosage or • due to a drug-drug interaction with medications such as; • diuretics and • NSAIDs. • Not to prescribe during pregnancy due to side effects

  5. Nursing Implications • Give during or after meals to decrease GI irritation • Monitor serum levels at least 2 weekly to stabilise manic episodes after stabilisation every month • Observe for decrease in manic behaviour and mood swings and drug interactions • Diuretics and anti inflammatory increase the effect of lithium • Avoid lithium toxicity check Electrolyte levels TSH T4, LFTs routinely

  6. Carbamazepine Uses • For anticonvulsant medication • Grand mal and partial Seizures • Blocks certain responses in the brain • Trigeminal neuralgia • Bipolar Disorder • Reduces anxiety • irritability elation • Impulse control behaviour

  7. Adverse Effects • Low WBC and Red blood cell count • Liver abnormalities such as jaundice • Thyroid abnormalities • Dizziness, Nausea, Vomiting, Unsteadiness • Increased risk of suicidal thinking and behaviours • photosensitivity reactions. • CNS: headache, tremors, confusion, restlessness, memory loss, seizures, slurred speech, muscle weakness, lack of coordination, lethargy, stupor • CV: bradycardia, ECG changes, arrhythmias, hypotension, peripheral circulatory collapse • EENT: blurred vision, tinnitus • GI: anorexia,, abdominal cramps or pain, diarrhoea, dry mouth, extreme thirst, metallic taste, weight gain • GU: polyuria, glycosuria, proteinuria, incontinence, oedema, hyponatremia • Hematologic: leukocytosis • Skin: rash, pruritus, alopecia, sweating, dryness or thinning of hair

  8. Precaution/ Contraindications Interacts with multiple drugs precautions should be taken when combining other medications These include: • Phenytoin • Primidone • Warfarin • Theophylline • Valproic Acid • Erythronycin • Cimetidine • Propoxyphine • Calcium Channel Blockers • Birth control pills Should not be used in pregnancy and breast feeding.

  9. Nursing implications • Take with food • Instruct patient to take carbamazepine around the clock, exactly as directed. • Advise patient not to take alcohol or other CNS depressant concurrently with this medication. • Apply sunscreen and wear sun smart clothing, U.V approved eye wear • Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum or lollies may help reduce dry mouth. Saliva substitute may be used.

  10. Sodium Valproate • Anticonvulsant • Antipsychotic • Mania

  11. Adverse effects • Haematological • Neurological • Liver dysfunction • Hyperammonaemia • Pancreatitis • GI Upset • Platelet dysfunction • Skin reactions • Hair loss • Oedema • Weight gain

  12. Precaution/ Contradictions • Pre existing liver dysfunction • Family history of • Severe hepatitis • Urea cycle disorders • Pregnancy • Impaired renal function • Abrupt Withdrawal • Diabetes • Thrombocytopenia • Platelet levels • Children • Kidney disease • Congenital Metabolic disorders • HIV • Organic brain disorders

  13. Nursing Implications • Monitor patient alertness • Evaluate plasma levels for toxicity • Baseline platelet count • Serum levels • LFT • UEC • FBC • Do not discontinue medication suddenly • Notify DR if spontaneous bleeding occurs

  14. Indicators of use for Olanzapine Antipsychotic Antimanic Mood stabiliser disabling high and low extremes of mood associated with bipolar I disorder. is used to treat symptoms of schizophrenia related psychoses. Dementia

  15. Adverse effects • Hypertension • Weight gain • Peripheral oedema • Precipitate type 2 diabetes • Cardiovascular disease • Severe CNS depression • Lactation • Narrow angle glaucoma • Transient elevation of liver enzymes • Drowsiness/ dizziness • GI upset • Constipation • Fever • Weight gain • Joint pain • Tachycardia • Bone marrow depletion • Cough and pharyngitis

  16. Precautions/Contraindications • Allergies to olanzapine • Myeloproliferative disorder • Lactation • Cardiovascular disease • Diabetes • Prostate enlargement • Breast cancer • pregnancy • Reacts with Other Drugs

  17. Nursing implications • Do not dispense more than 1 weeks supply at a time • Drug interaction • Monitor for dehydration • Monitor for sedation and decreased sensation • Urinary retention • Temperature • Hypertension • Take directly as prescribed • Take within 1 hour window of prescribed time

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