Educate client and family about the medication
Drug trade/ Generic names
First-line treatment for acute mania and for long-term prevention of recurrences
Lithium (Eskalith, Lithane, Lithobid, and Lithonate).
Interacts with sodium and potassium ions to stabilize electrical activity.
Fine hand tremors, polyuria, mild thirst, weight gain.
Early toxic – N, V, and D, thirst, polyuria, lethargy, slurred speech, muscle weakness
Advanced toxic – Course hand tremors, GI upset, confusion, sedation, incoordination
Severe toxic – Ataxia, confusion, large output of dilute urine, blurred vision, clonic movements, seizures, HTN, stupor and coma.
Therapeutic range of <0.4 to 1.5mEq/L
Frequent levels drawn
Toxicity- withhold med and draw level
Vigorously hydrate; use emetic, GI suctioning if overdose
Provide supportive nursing care for bedridden patient; may need peritoneal dialysis or hemodialysis
Depakote (Divalproex Sodium)
Tegretol (Carbamazapine) Lamictal (Lamotrigine).
Reduces the firing rate of high-frequency neurons. Is thought to reduce mood swings in patients with bipolar disorders.
Tremor, weight gain, sedation, anticholinergic side effects and rashes.
Liver panel and CBC with Depakote or Depakene.
CBC, electrolyte panel with Tegretol, along with an ECG.
Patients should report any rashes with Lamictal.