Mood stabilizers: Nursing pharmacology

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.Lithium should also be avoided in clients taking NSAIDs, ACE inhibitors, or diuretics, as well as those experiencing dehydration and hyponatremia, which can cause lithium retention and subsequently increase the risk of toxicity.

In fact, an important boxed warning is that clients must maintain normal fluid and salt intake during lithium therapy. Finally, lithium should be used with caution in clients with thyroid disease, as it may cause hypothyroidism.Now, before administering lithium, be sure to take a thorough history of all of the medications and supplements the client is taking and screen for any potential interactions.

In addition, because lithium is primarily excreted by the kidneys, assess the client’s baseline renal function, including electrolytes, BUN, and creatinine.

Check their baseline TSH and liver function tests as well, since lithium can also affect thyroid and liver function. Also assess their mental status; and lastly, ensure a negative pregnancy test for any client of childbearing age, since lithium can cause birth defects, especially in the first trimester.Next, ensure your client understands the importance of taking their medication as prescribed, without crushing or chewing the medication, and to not stop even when they start feeling better.

Encourage them to take their medication with meals or with milk to help limit gastrointestinal upset. And because lithium’s therapeutic index is so narrow, let your client know that their serum lithium levels will need to be checked every few days at the beginning of therapy to ensure the level is always below 1.5 mEq/L.

Once their levels have stabilized, they will need to be monitored regularly.Also stress the importance of keeping their daily fluid and sodium intake consistent, and explain how this helps the kidneys to keep their lithium level within a safe range.Remind them that vomiting, diarrhea, dehydration, and even hot weather can cause dangerous fluxuations in their lithium level.

Finally, be sure your client knows early signs of lithium toxicity such as thirst, lethargy, slurred speech, muscle weakness, and nausea, and to contact their healthcare provider right away if any of these are experienced.While caring for a client taking lithium, continue to monitor their mood and assess for the resolution of manic symptoms.

Regularly monitor their lithium level and other laboratory studies as indicated.Alright, as a quick recap… Mood stabilizers are medications used to treat bipolar disorder, for which, lithium is the first-line therapy.

Lithium helps to regulate the release of neurotransmitters, thereby reducing the erratic moods associated with bipolar disorder.

There are several contraindications and cautions that should be considered before administering lithium to clients, including hepatic or renal failure, pregnancy, age less than 12, and concurrent use of diuretics or NSAIDs.

Clients taking lithium need to take their medication as prescribed, maintain adequate hydration and sodium intake, and have their serum lithium level monitored closely to avoid