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.
- 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)
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.
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We’ll write everything from scratch
Mood stabilizers are considered the cornerstone in managing bipolar disorder and other related mood disorders of a depressive nature. They assist in stabilizing mood swings, decreasing the number and intensity of episodes, and enhancing the patient’s functioning. This paper aims to elaborately describe the following aspects of these medications: mechanism of action, baseline and monitoring examination, special population consideration, FDA approval indications, common dosage, drug interaction, and finally, ethical, legal, and social implications.
Carbamazepine
Proposed Mechanism of Action and Assessment and Labs
Carbamazepine affects voltage-gated sodium channels, stabilizes hyperexcited neuronal membranes, prevents repetitive neuronal firing, and decreases sympathetic neuronal transmission. It assists in controlling episodes of mania and depression in bipolar disorder; thus, it is taken to maintain stability (Maan & Saadabadi, 2023). At baseline, before using carbamazepine, a CBC, liver function tests, and serum sodium levels should be conducted. The medical checks relevant to such instances include assessment of hematologic alteration, hepatic function, and electrolyte variations. Thus, repeated tests are required, preferably annual examinations, although some patients need control every three to six months.
Special Population Considerations and FDA Approval Indications
Carbamazepine is reported to have a teratogenic effect if taken by a pregnant woman; hence, it should not be prescribed to pregnant women unless there is a justification for its use. For children and the elderly, the dosage should be different due to the different ways of metabolism and sensitivity of organisms. The drug is contraindicated for patients with hepatic and renal diseases; dose adjustments are needed for such patients to avoid toxicity. Carbamazepine is the only antiepileptic drug officially approved by the Food and Drug Administration (FDA) for bipolar disorder, epilepsy, and trigeminal neuralgia (Maan & Saadabadi, 2023). Lithium’s utility in averting the episodes and regulating the mood swings makes it valuable in the treatment of bipolar disorder.
Typical dosing
The starting dose of carbamazepine is 200 mg twice daily; typical dosage increments depend on the patient’s response and blood levels. The therapeutic levels vary from 4-12 μg/mL, which means that those patients within this range are safe to drive (Maan & Saadabadi, 2023). Serious consideration of serum level aids in checking toxicity as well as ensuring that the drug provides the needed therapeutic effect.
Major Drug-Drug Interaction Considerations
Carbamazepine interacts with many other drugs, and thus, one needs to be cautious while administering carbamazepine to a patient concurrently with other medications. For instance, it can enhance the CNS effects when administered concurrently with lurasidone, which requires regular monitoring and dose adjustment (Maan & Saadabadi, 2023). It was observed that carbamazepine concentrations were raised considerably when a subject consumed grapefruit juice; hence, it is advised that patients taking carbamazepine do not take grapefruit juice.
Lamotrigine
Proposed Mechanism of Action and assessment and labs
Lamotrigine is known to block voltage-sensitive sodium channels, stabilizing the neuronal membrane and preventing the release of excitatory neurotransmitters such as glutamate and aspartate. Favorably, this mechanism enables one to control the reoccurrence of mood episodes in bipolar disorder (Betchel et al., 2020). Any patient who is a candidate for lamotrigine requires a comprehensive skin check before the start of the drug due to the possible severe rash or even Steven-Johnson syndrome. The patients are also required to have blood tests once in a while to check for blood dyscrasias.
Special Population Considerations and FDA Approval Indications
Lamotrigine is pregnancy category C and should be used carefully during pregnancy; the pharmacokinetics of the drug alter during pregnancy, and dosage adjustments may be necessary. This occurs to avoid complications mostly due to the build-up of the drug in patients with renal problems. The dosing may also differ depending on the patient’s age, with children and senior citizens being prime examples. Lamotrigine has received FDA approval to be used to treat bipolar disorder and epilepsy (Betchel et al., 2020). Given its function to curb episodes of depression, it is highly effective in the maintenance phase of bipolar disorder.
Dosage Regimen and Therapeutic Targets and Major Drug-Drug Interaction Considerations
The initial dose for lamotrigine is usually 25mg/day, which is gradually titrated to a dose of 200mg/day because of the potential for rash development. The emphasis in therapeutic monitoring is on avoiding toxicity rather than targeting certain levels of the drug in the serum (Betchel et al., 2020). Interactions of lamotrigine are quite significant with other drugs. Lamotrigine level rises with valproate use, and thus, lower doses of lamotrigine should be prescribed to prevent a toxic effect. Rifampin causes the alteration of Lamotrigine concentration by responding to the hepatic enzymes; this causes an increase in the dosage of Lamotrigine to have the normative therapeutic consequence.
Lithium
Mechanism of Action and Assessment and labs
Lithium affects the metabolism of neurotransmitters, especially catecholamines and serotonin, and alters the way sodium is transported through nerve and muscle cells. Lithium may affect second messenger systems that regulate intracellular signaling by blocking inositol monophosphate (Chokhawala et al., 2024). Screening tests that should be performed before lithium is prescribed are renal profile, TSH, and serum electrolytes. The level of lithium in the patient’s serum should be checked frequently and should fall within the therapeutic range of 0. 6-1. It has been recommended that serum potassium levels should be kept at a level of not more than 2 mEq/L, and measures should be taken to avoid toxicity (Chokhawala et al., 2024). The determination of renal and thyroid function should be done every six months to check for any side effects.
Special Population Considerations FDA Approval Indications
Lithium should be prescribed with caution in the elderly because renal function decreases and sensitivity to side effects increases. Some of the renal implications that must be considered include the doses used in patients experiencing renal impairment are smaller, and administration is more frequent. Lithium should not be taken by pregnant women; even if taken at the initial stage of pregnancy, as it has disastrous effects on the unborn child(Chokhawala et al., 2024). Lithium is currently an FDA-approved drug for the management of bipolar affective disorder, mainly for the prophylaxis of manic episodes.
Usual Dosage and Objectives of Treatment and Major Drug-Drug Interaction Considerations
Lithium dose usually begins at 300 mg 2-3 times daily and is titrated according to the serum lithium levels. The target is to achieve values as close to 0. as possible, with the possibility of its fluctuations being within the therapeutic level. 6-1. 2 meq/L, and each of these serves to prevent both manic and depressive episodes while at the same time avoiding toxicity (Chokhawala et al., 2024). Lithium has many drug interactions with other medications. For instance, furosemide causes a decrease in the renal clearance of lithium and thus predisposes the patient to lithium toxicity and, therefore, requires constant monitoring and dosage adjustments. Lisinopril may also boost the lithium concentration; thus, stricter observance and maybe a decrease in the lithium dosage.
Valproate Products
Mechanism of Action and Assessment and labs
Valproate enhances the levels of another neurotransmitter, gamma-aminobutyric acid (GABA), within the brain, thus enhancing mood and hindering episodes of mania. Therefore, this makes it effective for the treatment of bipolar disorder (Rahman & Nguyen, 2023). The baseline assessments for valproate are assessment of liver function, platelet count, and assessments of coagulation. These parameters should be evaluated frequently for the identification of any early signs of hepatotoxicity and hematological alterations. It is vital to revisit the patient periodically to monitor the safety of the patient and the effectiveness of the drugs.
Special Population Considerations and FDA Approval Indications
Valproate is classified as a high teratogen, and thus, pregnant women should avoid taking valproate. As with many drugs, caution should be used with beclomethasone nasal administration in patients with hepatic impairment; dose adjustment and close monitoring are required if beclomethasone is to be used in such cases. Children and elderly patients may also need caution when it comes to the administration of the drugs as they have different pharma kinetic clearances. According to Rahman and Nguyen (2023), valproate is approved by the FDA for bipolar disorder, epilepsy, and the prevention of migraines. This aspect makes it useful when it comes to bipolar disorder treatment because it helps to control the occurrence of manic episodes.
Regular dosage and Reasons for Treatment and Major Drug-Drug Interaction Considerations
The initial dosage of Valproate is 250 mg two times a day, and further dosage adjustment is made according to the response and valproate level. It is normally dotted between 50-100mcg/mL to achieve the purpose of the medication without having to cause side effects Rahman and Nguyen (2023). Valproate has several drug interactions; some types of oral contraceptives contain estrogen and can decrease valproate levels, thus requiring the increased daily dose or choice of other birth control pills. It has been reported that amitriptyline may increase CNS effects, so care must be taken if this patient is to remain on this medication, and if so, the dosage may need to be adjusted.
Ethical, Legal, and Social Implications
The use of mood stabilizers entails some ethical issues like informed consent, effects of mood stabilizers, and autonomy. This means that patients should be fully informed about all the potential advantages and potential adverse effects of their prescriptions and be involved in the decision-making process (Beck et al., 2021). Some legal issues may include legal aspects of prescribing, patient rights to privacy, and documentation, among others. The findings suggest that mood stabilizers can affect the patient’s social life and interactions. Healthcare providers should also take into account the social factor that surrounds treatment, such as what patients may be stigmatized for taking psychiatric medications and how patients with certain illnesses may need support in adequately managing those illnesses (Nath & Gupta, 2020).
Conclusively, Carbamazepine, lamotrigine, lithium, and valproate are examples of anticonvulsant agents that are essential in the management of bipolar disorder and other mood disorders. Knowledge of their physiological action, initial and follow-up evaluation, management in special populations, FDA-approved indications, dosage, and pharmacokinetic interactions is core for practice. Furthermore, identifying and discussing the possible ethical, legal, and social issues related to these medications aims at providing patient-centered care.
Beck, N. S., Kim, D. S. J., & Dunn, L. B. (2021). Ethical Issues in Psychopharmacology. FOCUS, 19(1), 53–58. https://doi.org/10.1176/appi.focus.20200043
Betchel, N. T., Fariba, K., & Saadabadi, A. (2020). Lamotrigine. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470442/#:~:text=The%20mechanism%20of%20action%20for
Chokhawala, K., Saadabadi, A., & Lee, S. (2024, January 14). Lithium. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519062/
Maan, J. S., & Saadabadi, A. (2023, July 10). Carbamazepine. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482455/
Nath, M., & Gupta, V. (2020). Mood Stabilizers. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556141/
Rahman, M., & Nguyen, H. (2023, August 17). Valproic Acid (Divalproex Sodium). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559112/
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