Dose titration is guided by clinical response blurred

Dose titration is
guided by clinical
response.
blurred vision
or eye pain,
contact doctor
immediately.
mood changes,
signs of
depression.
Serum drug
levels, sodium
and bicarb
levels,
electrolytes and
ammonia if
there is mental
change
acute
myopia and
angle
closure
glaucoma,
suicide
behaviors,
ataxia,
paresthesia,
dizziness,
somnolence
, and
difficulty
concentrati
ng, weight
loss, kidney
stones
Rare:
oligohidrosi
s (decreased
sweating)
and
hypertherm
ia

Lithobid,
Eskalith
Lithium replaces
sodium during
depolarization
in neuronal
pathways,
effectively
stopping the
transmission of
electrical
impulses.
Additionally, it
is suspected
that lithium
acts on the
second
messenger
system
postsynapticall
y to inhibit
either the
inositol
monophosphat
ase enzyme to
modulate the G
proteins or the
messenger
RNA to alter
the protein
kinase C
Treatment of
manic phase of
bipolar
disorders and
prevention of
manic episodes
Acute mania: 600 mg
tid or 900 mg bid
Extended release
Maintenance: 300
mg tid qid or 450 mg
bid controlled
release
tremors,
nausea, and
drowsiness may
be signs of
toxicity. Blood
levels should be
obtained 14
days after
beginning
treatment and
14 days after
every dosage
change.
Generally,
routine blood
levels are
obtained every
3 to 6
ine tremors
of the
fingers,
nausea, dry
mouth,
headache,
and
drowsiness.
Lithium may
be taken
with food to
minimize GI
distress
Serious:
coarse
tremors of
the hands
that impair
function,
nausea and
vomiting,
diarrhea,
confusion,
stupor,
polydipsia
and
polyuria,
muscle
weakness,
and ataxia
Valproate Depakote blocks GABA
uptake into
presynaptic
neurons
without
affecting the
benzodiazepine
binding site. It
Complex
partial, simple
(petit mal),
absence seizure
epilepsy; mania;
migraine
headache
Initial 250 mg bid;
may increase 125–
250 mg weekly
CBCs and
serum levels 50-
125mcg/mL
Mild: GI
distress,
heartburn,
and CNS
depression

appears to
enhance GABA
function,
thereby slowing
down
repolarization
and reducing
glutamate
functioning at
the sodium and
calcium
channels
Benzodiazepine Xanax Alprazolam
inhibiting GABA
is to slow down
neurotransmissi
on and thereby
produce
reduction in
anxiety.
Serotonin as an
NT has a
calming effect
as well, owing
to the areas of
the brain
Anxiety
disorder, panic
disorder
Anxiety: 0.25–0.5 mg
tid, maximum 4
mg/d
Panic disorder: 0.5
mg tid, titrate q 3–4
d to 1–10 mg/d
(mean 5–6 mg/d)
Wean off slowly
when discontinuing
Liver function
and CBC
Paradoxical
anxiety,
agitation,
and acute
rage
Azapirone BuSpar Buspirone presynaptic 5-
HT 1a receptor,
buspirone is a
full agonist;
contributes to
the channel’s
opening and
permitting
serotonin
binding,
thereby
anxiety Initial: 5 mg BID or
TID 4 days
increased by 5 mg
each dose to a
maximum dose of 60
mg per day
Medications
effectiveness
and mood
light-
headedness,
headache,
insomnia,
nausea,
nervousness
, and dry
mouth.