Antimanic drugs And Nursing Role

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Definition of Antimanic drugs

A group of medication used to treat manic episodes and bipolar disorder as a prophylaxis

Action of Antimanic drugs

– Enhance re-uptake of serotonin and nor epinephrine , so improve the mood

– Block sensitive dopamine receptor ,so decrease activity and prevent development of new dopamine receptor

– Alternation of sodium metabolism

 

Type of drug :

Generic name : Lithium

Trade name : Lithane , Lithotabe , Lithonate , Duralith , lithizin , Berianil , beriadil

 

Dose :

  • Initial dose : 300 – 600 mg ; 3 times / day = 900-1800/day
  • Maintenance dose : 300 – 1200 mg
  • Normal level of lithium in blood: 0.7 – 1.2 mEq/l = 300 – 2700 mg/l

 

Indications of Antimanic drugs

1- mania

2- Bipolar disorder

3- psychomotor hyperactivity ( Block dopamine )

4- Schizophrenia ( Prevent development of new

dopamine receptor )

5- Restlessness

6- Aggression

7- Hostility

8- Irritability

9- Prevent conduct disorder

10- Mental retarded p.t

11- Premenstrual dysphoric syndrome

12- Bulimia nervosa

13- Border line personality disorder

 

Contraindication of Antimanic drugs

1. Pregnancy

2. Medical disorder ( D.M , sever CVD , Thyroid disorder , Renal and liver disease , Urinary retention )

3. Brain damage

4. Hypersensitivity to the drug

5. History of seizure

6. Old p.t

7. Sever dehydration

 

Side effects of Antimanic drugs

1. Neurological : Dysphoria ; Ataxia ; Dysarthria ; E.P tremor ; Neuromuscular irritability

2. Musculoskeletal : Peripheral neuropathy ; Lowered seizure threshold during sleep

3. Endocrine : Goiter ; Hyper/Hypothyroidism

4. Cardiovascular : Sinus node dysfunction

5. Renal : Polyuria ; Nephrotic syndrome ; Renal tubular acidosis ; Morphological changes ; Renal failure

6. G.I.T : Nausea ; Vomiting ; Diarrhea ; Dry mouth ; Loss of appetite

7. Skin : Acne ; Rash ; Psoriasis

8. Miscellaneous : Altered CHD metabolism ; W.T gain ; Fluid retention

 

Lithium toxicity :

Causes :

* ↓ Renal function

* ↓ Sodium intake

* Use of diuretic

* Fluid and electrolyte imbalance

* Excessive sweating

* Over dose of lithium

Degrees of toxicity :

1. Below 1.5 mEq/l ( Mild )

  • Fine hand tremor
  • Increase urination
  • Dry mouth and thirst
  • Nausea

2. 1.5 – 2 mEq/l :

  • Dry mouth
  • Vomiting
  • Abdominal pain
  • Muscle weakness
  • Diarrhea

3. From 2-2.5 mEq/l:

  • Muscle weakness
  • Blurred vision
  • Sever diarrhea
  • Muscle twitching

4. From 2.5 – 3 :

  • Myoclonic twitching
  • Chorea
  • Urinary and fecal incontinence

5. More than 3 mEq/l :

  • Seizure
  • Cardiac disrrhythmia
  • Hypotension
  • Peripheral vascular collapse
  • STUPER , Coma and Death

Treatment of toxicity :

1. Stop the drug

2. Enter the p.t I.C.U

3. Maintain patent airway

4. Insert N.G.T if conscious

5. Gastric lavage and gastric decontamination

6. Administer I.V fluid ( Sodium chloride )

7. Hemodialysis if renal failure occur

8. Monitor vital signs frequently

9. Monitor cardiac function

10. Give O2 therapy if needed

11. Monitor lithium level every 3 hours

 

Schedule for lithium monitoring :

1. Sample should be taken from 10-12 hrs after the last dose of lithium

2. In the first 2 months it should be taken every week

3. After 2 months it should be taken every month

Nursing role for lithium administration :

1. Obtain medical and psychiatric history

2. Obtain physical history

– Thyroid , C.B.C and serum electrolyte test

– TSH and creatinine level every 6 months

– Lithium level in the blood frequently

– ECG

 

Health teaching :

1. Avoid ↑ or ↓ sodium in the diet

2. ↑ Fluid intake

3. Avoid diet containing beverage

4. Avoid excessive exercise in ho weather

5. Avoid alcohol intake

6. Swallow the drug and avoid chewing it

7. Take the drug with juice or food

8.Use family planning method to avoid pregnancy

9. Avoid stopping the drug without doctor order

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