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Mood stabilizers: Nursing Pharmacology



lithium (Lithobid)
Mood stabilizer; antimanic agent
  • Inhibition of norepinephrine and dopamine release in the brain
  • Increase of serotonin production in the brain
  • Alteration of Na+/ K+ ion transport (brain, muscle cells)
Bipolar disorder
  • Nausea, vomiting, diarrhea
  • Muscle weakness, hyperreflexia, ataxia
  • Slurred speech
  • Seizures
  • Nephrogenic diabetes insipidus (polyuria, polydipsia)
  • Serotonin syndrome
  • Boxed warning: toxicity
  • Pregnancy, breastfeeding
  • Children < 12 years
  • Cardiac / renal / hepatic impairment
  • Schizophrenia, brain trauma, brain organ syndrome
  • NSAIDs, ACE inhibitors, diuretics
  • Dehydration, hyponatremia
  • Thyroid disease
Assessment and monitoring
  • Mental status
  • Medication history
  • Baseline labs: BUN, creatinine, electrolytes, TSH, liver function, thyroid function, negative pregnancy test

Client education
  • Take as prescribed; do not crush or chew
  • Do not stop even if feeling better
  • Take with meals or milk
  • Regular monitoring of lithium levels required
  • Keep fluid and sodium balance consistent
  • Report signs or symptoms of toxicity

Mood stabilizers are medications used to treat bipolar disorder, which is a mental health condition characterized by dramatic shifts in emotions, mood, and energy levels.

In other words, a person with bipolar disorder can alternate from extreme lows to extreme highs, so mood stabilizer medications can help smooth out these mood swings.

Now, the first-line mood stabilizer is lithium, but other medications can also be used, including antiepileptics, such as carbamazepine, valproic acid, and lamotrigine; and antipsychotics, like olanzapine.

Now, lithium is taken orally, and it’s rapidly absorbed by the gastrointestinal tract. Once absorbed, it travels to the brain and regulates the release of neurotransmitters through an unclear mechanism.

In particular, lithium seems to inhibit the release of norepinephrine and dopamine, while it increases the production of serotonin and alters the sodium-potassium ion transport in neurons, as well as in muscle cells.

It’s important to note that lithium has boxed warning for toxicity because it has a narrow therapeutic index, meaning that small variations in its blood concentrations can result in serious side effects and toxicity.

The most common causes of lithium toxicity include increased lithium dosage; decreased renal elimination, which is especially common in clients with kidney problems or hyponatremia; and the use of medications that can affect renal clearance, such as NSAIDs, ACE inhibitors, and diuretics.

Now the most important side effects of lithium toxicity include thirst, lethargy, slurred speech, and muscle weakness, as well as gastrointestinal side effects, such as nausea, vomiting, and diarrhea.

In addition, individuals may develop seizures, hyperreflexia or overactive reflexes, and ataxia, which refers to a lack of coordination and muscle control.

Another important side effect of lithium therapy is nephrogenic diabetes insipidus, which is characterized by polyuria or the production of large quantities of very dilute urine, as well as polydipsia or extreme thirst. Fortunately, this can be reversed by discontinuing lithium.

Finally, a potentially life-threatening effect of lithium therapy, especially when combined with certain antidepressant medications, is serotonin syndrome, which is caused by high levels of serotonin in the brain.

This typically presents with skin flushing, hyperthermia, agitation, muscle rigidity, seizures, and altered mental status or even coma.

Finally, lithium is contraindicated during pregnancy and breastfeeding, as well as in children under the age of 12. Also, this medication should not be used in clients with severe cardiac and renal impairment, since these conditions can cause variations in its blood concentrations and result in lithium toxicity.

Other important contraindications include hepatic impairment, schizophrenia, and brain trauma, as well as organic brain syndrome, which refers to all diseases of the brain that are manifested by psychiatric signs and symptoms.

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  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  5. "Overview of the mechanism of action of lithium in the brain: fifty-year update" Journal of Clinical Psychiatry (2000)
  6. "NURSING PROCESS FOCUS Clients Receiving Lithium (Eskalith)"  ()