Nurs6630 Week 8 Mood Stabilizer

Nurs6630 Week 8 Mood Stabilizer

Mood stabilizers play a crucial role in managing bipolar disorder and other mood disorders. These medications are used to control fluctuations in moods and to prevent periods of increased and decreased energy and activity, known as mania and depression. This paper focuses on four conventional mood stabilizers: carbamazepine, lamotrigine, lithium preparations, and valproate products. It also presents information regarding the mechanisms through which the medications work, premeditations, clinical and laboratory implications, dosing, drug-drug interactions, and dosing adjustment in special populations. Moreover, evaluation of the ethical, legal, and social issues related to the use of these medications is highlighted.

Carbamazepine

Proposed Mechanism of Action

Carbamazepine is used as an anticonvulsant and for the management of bipolar disorder, and it is mainly associated with the blockade of voltage-gated Sodium channels in the brain. This inhibition decreases the levels of excitatory neurotransmitters and, thereby, decreases the excitability of neurons and helps to maintain the mood within a stable range. It also influences neurotransmitters such as serotonin and dopamine, which account for the drug’s mood-leveling impact (Simeone et al., 2021).
Baseline Assessment, Laboratory Considerations, and Frequency of Ongoing Labs and Assessments

Comprehensive baseline investigations for any patients initiating carbamazepine encompass a complete blood count in addition to liver and renal function tests; an electrocardiogram should also be conducted because of the cardiovascular side effects of carbamazepine. Blood dyscrasias and hepatic and renal impairment make it mandatory to routinely monitor patients on this drug. CBC and LFTs should be repeated periodically for patients with gallstones (Simeone et al., 2021). To screen for RSI, the first examination should be done at recruitment and then annually or bi-annually with further examinations when clinically required.

Special Population Considerations

Women would require special attention so as to address issues involving hormonal contraceptives. Carbamazepine affects the metabolism of combined contraceptives, and therefore, it is likely to increase the risk of pregnancy among women of childbearing age who are under treatment with carbamazepine. Elderly patients need dosing changes because their tolerance to some medications is lower, and they are also susceptible to some side effects like low sodium levels and frequent falls. Special consideration should be applied to patients with renal or hepatic diseases because of the changed pharmacokinetics. It should be more monitored in such groups to avoid cases of toxicity.

FDA Approval Indications

Carbamazepine is endorsed for bipolar disorders, epilepsy, and trigeminal neuralgias, further proving its readiness to handle a variety of neurological disorders.

Typical Dosing and Therapeutic Endpoints

The first dose should be 200 mg within two doses per day, then gradually increasing total dosages of 800-1,200 mg at a time, depending on the outcomes of the former process and the patient’s tolerance level. This is because the therapeutic range of carbamazepine has to be between 4-12 mcg/mL of serum concentration in order to avoid toxicity while at the same time maximizing efficacy. If the clinical response differs, adjustments have to be made the same way as in the case of side effects.

Major Drug-Drug Interaction Considerations

Lurasidone is metabolized by oxidation, and carbamazepine decreases lurasidone plasma concentration by inducing the oxidation process of the atypical antipsychotic medication. Dosage alteration or change in the type of antipsychotic medication may be called for. Citrus juices, notably grapefruit juice, affect carbamazepine plasma concentration by decreasing its metabolism, and thus, the toxicity level is increased. It is pertinent that the patient does not take grapefruit juice to avoid any harm.

Lamotrigine

Proposed Mechanism of Action

Lamotrigine stabilizes neuronal membranes by inhibiting voltage-sensitive sodium channels. It modulates the release of excitatory neurotransmitters like glutamate and aspartate, contributing to its mood-stabilizing effects. This action helps prevent the excessive neuronal firing that characterizes mood swings in bipolar disorder (Costa & Vale, 2023).
Baseline Assessment, Laboratory Considerations, and Frequency of Ongoing Labs and Assessments
Initial assessments include a skin examination (due to the risk of Stevens-Johnson syndrome), renal function tests, and liver function tests. Regular monitoring is crucial to detect early signs of severe skin reactions and assess liver and kidney function. Baseline tests should be followed by periodic monitoring every 6-12 months.

Special Population Considerations

Women on hormonal contraceptives may require dose adjustments due to potential interactions. Lamotrigine levels can be affected by estrogen-containing contraceptives, requiring closer monitoring. Elderly patients may be more sensitive to side effects and require lower doses (Cooper et al., 2022). Adjustments should be made based on tolerability and renal function. Dosing should be adjusted in patients with hepatic or renal impairment to prevent accumulation and toxicity.

FDA Approval Indications

Lamotrigine is approved for the maintenance treatment of bipolar disorder and as adjunctive therapy for partial seizures, highlighting its dual role in managing both mood and seizure disorders.

Typical Dosing and Therapeutic Endpoints

Treatment should start with 25 mg daily, increasing gradually to a maintenance dose of 100-200 mg per day to minimize the risk of rash. Slow titration is critical to avoid serious skin reactions. The goal is effective titration to achieve mood stabilization while avoiding dose-dependent side effects. Regular assessment of mood symptoms and side effects is necessary.

Major Drug-Drug Interaction Considerations

Valproate increases lamotrigine levels, necessitating careful dose adjustments to avoid toxicity. Starting doses of lamotrigine should be halved when used with valproate. Rifampin reduces lamotrigine levels, potentially requiring dose increases. Monitoring and adjustment are essential to maintain therapeutic effectiveness.

Lithium

Proposed Mechanism of Action

Lithium’s exact mechanism is not fully understood, but it is believed to stabilize mood by affecting neurotransmitter activity and neuronal excitability. It modulates second messengers, such as inositol monophosphatase, contributing to its therapeutic effects. Lithium may also influence serotonin and norepinephrine levels, which are implicated in mood regulation (Pisano et al., 2019).

Baseline Assessment, Laboratory Considerations, and Frequency of Ongoing Labs and Assessments

The baseline investigations consist of tests such as renal function tests, thyroid function tests, ECG, and pregnancy tests in female patients. Meaningful periodic checks of lithium levels and renal and thyroid function are mandatory in order not to miss toxicity and side effects. Lithium blood levels should be measured daily within 4-5 days after dose adjustments and then at intervals of 3-6 months. Patients should undergo renal and thyroid profiling at least once every six to twelve months to assess for early manifestations of organ damage.

Special Population Considerations

Dose adjustments may be required for women owing to changes in renal function during pregnancy. Lithium is also prohibited during the first trimester of pregnancy due to potential teratogenic effects. The doses are usually lower in elderly patients because this population is at a higher risk of developing toxicity. Particular attention should be paid to any symptoms of toxicity, including the development of tremors or cognitive deficits. Additionally, patients with renal or thyroid disorders should be monitored because lithium worsens these conditions. Close supervision and dosage adjustments according to a patient’s renal status are required.

FDA Approval Indications

Lithium has been approved for bipolar disorder, especially for acute mania and the maintenance phase. Due to its effectiveness in both preventing episodes of mania and depression, this medication is a mainstay of bipolar disorder treatment.
Typical Dosing and Therapeutic Endpoints
The initial dose should be equal to 300 mg, and treatment should be given 2-3 times per day while controlling serum level that should be 0. 6-1. 2 mEq/L. This suggests that it is important that the serum level is frequently closely monitored in an effort to prevent toxicity (Nolen et al., 2019). The purpose is to try to keep the serum lithium concentrations in the range that is effective and, as far as possible, not toxic. Dosage modifications should depend on patients’ general clinical response and side effects.
Major Drug-Drug Interaction Considerations
Lithium toxicity may be more likely if taken together with furosemide because renal clearance is affected. It also recommended that lithium concentrations should be well-supervised and the amount of medication administered should be changed accordingly. Also, lithium levels rise, and the risk for toxicity elevates when joined with lisinopril. This requires constant observation and, sometimes, modification of the dosage to avoid side effects.

Valproate Products

Proposed Mechanism of Action

Valproate helps to boost the levels of a neurotransmitter called gamma-aminobutyric acid (GABA), thus acting as an inhibitory neurotransmitter; it slows down neuronal activity and regulates mood. Valproate has a modulating effect on the GABA component, for which it increases GABAergic inhibition and consequently decreases neuronal excitability, which helps stabilize moods in bipolar disorder (Romoli et al., 2019).

Baseline Assessment, Laboratory Considerations, and Frequency of Ongoing Labs and Assessments

Baseline assessments should include CBC, liver function tests, and a pregnancy test for women of childbearing age. Regular monitoring of CBC, liver function, and serum valproate levels is necessary to avoid toxicity. Monitoring for signs of hepatic dysfunction and hematologic abnormalities is crucial. Baseline tests should be conducted, with CBC and LFTs monitored every six months and serum valproate levels checked as clinically indicated.

Special Population Considerations

Teratogenic effects warrant caution in women of childbearing age. Use contraception to avoid pregnancy and consider alternative mood stabilizers if pregnancy is planned. Special considerations may be necessary, especially for patients of advanced age, due to the increased susceptibility of older adults to certain doses (Romoli et al., 2019). The three related side effects that need to be closely observed are sedation and hepatic dysfunction. It is advisable to exercise much care in unlaced complications of hepatic dysfunction and metabolic diseases. This leads to potential toxic effects; thus, dose adjustments and monitoring are necessary.

FDA Approval Indications

Valproate is approved for the treatment of bipolar disorder, epilepsy, and migraine prophylaxis, underscoring its wide therapeutic applications.

Typical Dosing and Therapeutic Endpoints

Treatment should start with 250 mg twice daily, increasing based on clinical response and serum levels. Therapeutic levels range from 50-125 mcg/mL for mood stabilization. The goal is to achieve and maintain therapeutic serum levels while monitoring for side effects such as weight gain, sedation, and hepatic dysfunction.

Major Drug-Drug Interaction Considerations

Estrogen can decrease the level of valproate in blood and its efficacy. Requirements for another type of contraceptives or a change in the dosage of the present contraceptives may be recommended. Also, possible additive effects when used with amitriptyline and cases of CNS depression and other side effects are likely when used in combination. As such, patients’ safety is maintained from daily fluctuations that may lead to pathologic changes if not closely watched and appropriate doses adjusted.

Ethical, Legal, and Social Implications

The therapeutic use of mood stabilizers raises a number of ethical, legal, and social issues in order to guarantee safe and adequate patient care. Some of the issues to ponder are patients’ autonomy, voluntary consent, and the possibility of teratogenicity, especially in women of childbearing age. Legal aspects entail observing the prescription measures, side effect evaluation, and documentation to reduce risks of legal action. Some social factors include stigma related to mood disorders and equal distribution of treatments and medications to patients of all classes.

Conclusion

It is crucial that prescribers have a keen understanding of the mechanisms of action, initial screening tests, laboratory values, dosing, drug-drug interactions, and considerations for special populations with carbamazepine, lamotrigine, lithium, and valproate. Notably, by applying not only empirical support and EBP but also ethical, legal, and social considerations into practice, healthcare providers can enhance patients’ outcomes of bipolar disorder and other mood disorders. Accordingly, this outlook provides optimum and suitable treatment to patients and reduces potential risks significantly while improving the quality of life.

References

Cooper, D. B., Mahdy, H., & Patel, P. (2022, November 24). Oral contraceptive pills. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430882/

Costa, B., & Vale, N. (2023). Understanding lamotrigine’s role in the CNS and possible future evolution. International Journal of Molecular Sciences, 24(7), 6050. https://doi.org/10.3390/ijms24076050

Nolen, W. A., Licht, R. W., Young, A. H., Malhi, G. S., Tohen, M., Vieta, E., Kupka, R. W., Zarate, C., Nielsen, R. E., Baldessarini, R. J., & Severus, E. (2019). What is the optimal serum level for lithium in the maintenance treatment of bipolar disorder? A systematic review and recommendations from the ISBD/IGSLI Task Force on treatment with lithium. Bipolar Disorders, 21(5), 394–409. https://doi.org/10.1111/bdi.12805

Pisano, S., Pozzi, M., Catone, G., Scrinzi, G., Clementi, E., Coppola, G., Milone, A., Bravaccio, C., Santosh, P., & Masi, G. (2019). Putative mechanisms of action and clinical use of lithium in children and adolescents: A critical review. Current Neuropharmacology, 17(4), 318–341. https://doi.org/10.2174/1570159X16666171219142120

Romoli, M., Mazzocchetti, P., D’Alonzo, R., Siliquini, S., Rinaldi, V. E., Verrotti, A., Calabresi, P., & Costa, C. (2019). Valproic acid and epilepsy: From molecular mechanisms to clinical evidence. Current Neuropharmacology, 17(10), 926–946. https://doi.org/10.2174/1570159×17666181227165722

Simeone, T. A., Heruye, S. H., Kostansek, J. A., Yeh, M. Y., Matthews, S. A., Samson, K. K., & Simeone, K. A. (2021). Carbamazepine reduces sharp wave-ripple complexes and exerts synapse-specific inhibition of neurotransmission in ex vivo hippocampal slices. Brain Sciences, 11(6), 787. https://doi.org/10.3390/brainsci11060787

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Nurs6630 Week 8 Mood Stabilizer

This Assignment is designed to help you analyze the many considerations for prescribing mood stabilizers, as well as organizing the many different lab components to consider when prescribing to a patient.

TO PREPARE

• Review the Required Learning Resources.
• Review indications and considerations for traditional mood stabilizer psychopharmacology treatments, including carbamazepine, lamotrigine, lithium, and valproate products.

THE ASSIGNMENT

Construct a 5- to 6-page paper discussing each of the four traditional mood stabilizer medications: carbamazepine, lamotrigine, lithium, and valproate products. Support your answers with five (5) evidence-based, peer-reviewed scholarly literature.

Note: APA style format will apply.

Your paper should include the following for each:

• Proposed mechanism of action
• Baseline assessment, laboratory considerations, and frequency of ongoing labs and assessments
  • Note: Discuss the importance of assessment and labs.
• Special population considerations (birth assigned gender, age, other medical comorbidity considerations)
• FDA approval indications
• Typical dosing with discussion on therapeutic endpoints for psychiatric use
• Major drug–drug interaction considerations
  • For each of these medications, please review potential drug–drug interactions listed below. Consider alternative dosing schedules, clinical implications for the drug interactions, additional patient education needed, any additional monitoring recommended, or collaboration needed with other medical professions (such as, primary care providers)
    • Lamotrigine + Valproate
    • Lamotrigine + Rifampin
    • Valproate + Estrogen containing birth control.
    • Valproate + Amitriptyline
    • Lithium + Furosemide
    • Lithium + Lisinopril
    • Carbamazepine + Lurasidone
    • Carbamazepine + Grapefruit juice
  • Discuss the ethical, legal, and social implications related to prescribing bipolar and other related mood-disorder diagnoses therapy for patients.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. For this Assignment, you are only required to include a title page. The Walden Writing Center Sample PaperLinks to an external site. provides an example of those required elements.

BY DAY 7 OF WEEK 8

• Submit by Day 7 of Week 8.

SUBMISSION INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

• To submit your completed assignment, save your Assignment as WK8Assgn_LastName_Firstinitial