Lithium
What is Lithium class of medication?
Mood Stabilizer.
Lithium Toxicity less than 1.5 mEq/mL
Common adverse effects:
• Diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, fine hand tremors, slurred speech, lethargy
Nursing Action: Instruct the patient that manifestations at low levels often improve over time
Name the medications?
- Isocarboxazid ( Marplan )
- Phenelzine ( Nardil )
- Tranylcypromine ( Parnate )
- Selegiline ( Emsam ) - a transdermal patched
What is the class of mecdication
Tricyclic Antidepressants.
Selective Serotonin Reuptake Inhibitors
What is the class of medication
Serotonin and Norepinephrine Reuptake Inhibitors.
Vagal Nerve Stimulation (VNS)
A vagal nerve stimulator is implanted, through an outpatient procedure, in the left chest wall
Bupropion (Wellbutrin)
Norepinephrine - Dopamine Reuptake Inhibitors (NDRIs)
Action: inhibition of norepinephrine, serotonin, and dopamine reuptake
Side effects: agitation or anxiety, insomnia, appetite suppression, psychosis
Carbamazepine (Tegretol)
Valproic Acid (Depakote)
Lamotrigine (Lamictal)
Topiramate (Topamax)
Oxcarbazepine (Trileptal)
What is lithium used for?
- Bipolar Disorder
-Controls episodes of acute mania, helps to prevent the return of mania or depression, and decreases the incidence of suicide
Manifestations
• Mental confusion, sedation, poor coordination, coarse tremors, ongoing GI distress (nausea, vomiting, diarrhea)
• Nursing Actions: Instruct the patient to withhold administering the medication and contact their provider ,Administer new dosage based on blood lithium and sodium levels , May promote excretion
MAOIs side effects?
- drowsiness , dizziness , fatigue , seizures , headache , hyperreflexia , Insomnia , Tremor , Twitching , Weakness , Orthostatic , Orthostatic Hypotension , Hypertensive crisis , edema , constipation , dry mouth
- Amitriptyline (Elavil)
- Amoxapine (Asendin)
- Doxepin (Sinequan)
- Imipramine (Tofranil)
- Desipramine (Norpramin)
- Nortriptyline (Pamelor)
- Clomipramine (Anafranil)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
What is the names of SSRI's
Citalopram (celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Luvox)
What are the names of SNRIs
-Duloxetine (Cymbalta) -Venlafaxine (Effexor)
Deep Brain Stimulation (DBS)
Implant electrodes surgically into the brain to stimulate underactive regions
More invasive than the VNS (implanted surgically)
Mirtazepine (Remeron)
Antidepressant Medications: a2 Antagonist NaSSA ( noradrenergic and specific serotonergic antidepressants )
Action:Boosting norepinephrine/noradrenaline and serotonin by blocking a2 - adrenergic presynaptic receptors on a serotonin receptor
Side effects: sedation (at lower doses), dizziness, weight gain, dry mouth, constipation, change in urinary function
Carbamazepine side effects.
- CNS effects
- Blood dyscrasias (any disease or disorder that affects the blood, bone marrow, or lymph tissue.)
-Teratogenesis (the process by which physical, chemical, or biological agents disrupt normal embryonic or fetal development, resulting in birth defects, functional impairments, or pregnancy loss)
-Hypo-osmolarity ( low concetration od solutes ( particales) in the blood plasma)
- Skin disorders
what is the adverse effects?
Nausea, Diarrhea, Abdominal pain, Fine hand tremors, Polyuria, Weight gain, Renal toxicity, Goiter, Hypothyroidism, Bradydysrhythmias, Hypotension, Electrolyte imbalances
Lithium Toxicity 2.0 to 2.5mEq/mL?
• Manifestations: Extreme polyuria of dilute urine, tinnitus, giddiness, jerking movements, blurred vision, ataxia, seizures, severe hypotension, stupor leading to coma, and possible death from respiratory complications
• Nursing Actions: Administer an emetic if the patient is alert, otherwise, administer gastric lavage, Urea, mannitol, or aminophylline may be prescribed to increase rate of excretion
Nursing Implications
- assist the patient to rise slowly
- administer in the AM and administer with food
-ensure adequate fluids
- teach about importance low tyramine diet
What is the adverse effects of TCAs
- suicidal thoughts
- arrhythmias
- drowsiness
- fatigue
-lethargy
- blurred vision
- dry eyes
- dry mouth
- hypotension
- constipation
What is SSRIs used to treat?
OCD , Depression, Anxiety
What are the side effects of SNRIs?
Abnormal dreams, Anxiety Dizziness, Headache,Insomnia, Weakness Rhinitis, Chills Paresthesia, NMS ,Serotonin Syndrome,Suicidal Thoughts, Seizures, Visual disturbances, Abdominal pain, Altered taste Anorexia, Constipation, Diarrhea, Dry mouth Nausea, Vomiting, Weight loss, Ecchymoses, Nervousness, Dyspepsia
Light Therapy
Can be used for those patients who experience seasonal affective disorder (SAD) because of the lack of sunshine
Trazodone ( Desyrel )
Action: Blocking of serotonin 2A receptor and less potently blocks the serotonin reuptake pump
Side effects: sedation, weight gain, nausea, vomiting, constipation, dizziness, fatigue, incoordination, tremor
Lamotrigine side effects
Double or blurred vision, dizziness, headache, nausea, vomiting
serious skin rashes
Whaat is the theraputic level of Lithium?
Lithium Toxicity Greater than 2.5 mEq/mL
Manifestations:
Rapid progression of manifestations leading to coma and death
• Nursing Actions: Hemodialysis may be warranted
What are the foods to avoid?
Food containing tyramine
- aged cheese, wine; beer, chocolate; colas, coffee; tea, sour cream; yogurt, smoked and processed meats, beef or chicken liver, canned figs, caviar, raisins, pickled herring, yeast products, broad beans, soy sauce, cold remedies, diet pills
Drugs that interact with TCAs
MAOI’s: High fever, convulsions, death
Saint John’s Wort, tramadol (Ultram): Seizures, serotonin syndrome
Clonidine (Catapres), epinephrine: Severe hypertension
Acetylcholine blockers: Paralytic ileus
Alcohol and carbamezipine (Tegretol):Blocks antidepressant action, increases sedation Cimetidine (Tagamet),
bupropion (Wellbutrin): Increased TCA blood levels, increased side effects
What are the side effects of SSRIs
- insomnia - Diarrhea - Nausea -NMS -Suicidal thoughts-Serotonin Syndrome - sexual dysfunction - headache - weight gain - Lethargy
Patients whose depressive disorders are nonresponsive to SSRI treatment are commonly prescribed SNRIs. How do these medications differ from SSRIs?
The medication differs because SNRIs affect norepinephrine and serotonin, while SSRIs only affect serotonin reuptake.
What is ECT?
Electroconvulsive Therapy ( ECT ) Brief seizures are induced by electrical current attached to one or both (unilateral or bilateral) sides of the forehead
Mechanism of Action: Thought to increase levels of biogenic amines
Side Effects: Temporary memory loss and confusion
Risks: Mortality, permanent memory loss, brain damage • Medications • Pre-treatment medication, muscle relaxant, short-acting anesthetic
Vilazodone
Action: inhibits reuptake of serotonin, partial agonist of 5 - HT1A
Valporate side effects
Double or blurred vision, dizziness, headache, nausea, vomiting Serious skin rashes GI effects, hepatotoxicity, pancreatitis, thrombocytopenia, teratogenesis, weight gain
Drug Interactions with Lithium?
Diuretics: Sodium is excreted with the use of diuretics. With decreased blood sodium, lithium excretion decreases, which can lead to toxicity.
NSAIDs: Concurrent use of NSAIDs increases renal reabsorption of lithium, leading to toxicity
Anticholinergics: Abdominal discomfort can result from anticholinergic-induced urinary retention and polyuria
What do you monitor for Lithium?
-blood levels for toxicity (severe diarrhea, vomiting, drowsiness, muscular weakness, and lack of coordination); drug held if symptoms occur
-Creatinine concentrations, thyroid hormones, and CBC every 6 months ▪ Renal function (kidney damage possible)
-Thyroid function (possible alteration after 6 to 18 months); observation for dry skin, constipation, bradycardia, hair loss, and cold intolerance
Avoid if pregnant or breastfeeding.
Drugs that interaction with MAOIs
Interacting Drugs Adverse Effects SSRI’s, TCA’s , atomoxetine (Strattera), duloxetine (Cymbalta), dextromethorphan (an ingredient in many cough syrups), venlafaxine (Effexor), St. John’s Wort, ginkgo: Serotonin syndrome
Morphine and other narcotic pain relievers, antihypertensives :Hypotension
All other antidepressants, pseudoephedrine, amphetamines, cocaine cyclobenzaprine (Flexeril), dopamine, methyldopa, levodopa, epinephrine, buspirone (BuSpar): Hypertensive crisis (these side effects can occur even if taken within 2 weeks of stopping MAOI’s)
Buspirone (BuSpar): Psychosis, agitation, seizures
Antidiabetics: Hypoglycemia
Tegretol Fever, hypertension, seizures
What deadly reaction do you monitor for?
What is QT Prolongation
What is Torsades de Pointes
Drugs Interactions with SSRIs
Antiepileptics: lowered seizure threshold
Information to know about ECT.
The only absolute contraindication is increased intracranial pressure
Side Effeccts: Immediately after: Temporary periods of memory loss, confusion Slight headache or muscular aches ,In conjunction with medication and/or other therapies
Pre-treatment : Benzodiazepines should be discontinued ;NPO 6-8 hours prior to treatment ;Rapid-acting anesthetic and a muscle-paralyzing
Blood pressure cuff goes around one of the patient’s lower legs • Inflate to above the systolic pressure prior to administration of the paralytic agent • This allows the treatment team to witness seizure activity in the great toe • Seizure activity lasting 45 to 60 seconds is considered effective. • Monitor the patient’s status and respond to any emergencie
Vortioxetine
Action: Inhibits reuptake of serotonin and norepinephrine, partial agonist to 5 - HT
Drug interactions
Carbamazepine: Oral contraceptives, warfarin, Grapefruit juice, Concurrent use of other anticonvulsants
Lamotrigine : Carbamazapine, phenytoin, phenobarbital, Concurrent use of valproate, Oral contraceptives
Valproate: concurrent use of other anticonvulsants