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Mood Stabilizing Antiepileptics Cheat Sheet by

Carbamazepine, valproic acid, lamotrigine


Valproic Acid
Oxcarb­azepine and topiramate are less frequently used and recomm­ended for mainte­nance treatment of bipolar disorder.


Heal treat and manage bipolar disorders by various mechanisms
Slowing the entrance of sodium and calcium back into the neuron and thus extending the time it takes for the nerve to return to its active state
Inhibiting glutamic acid (gluta­mate) which in turn suppresses CNS excitation

Therap­eutic Uses

Treatment and prevention of relapse of manis and depressive episodes
Especially useful for clients who have mixed mania and rapid cycling bipolar disorders

Compli­cations of Lamotr­inige

Nursing Action and Education
Double vision, blurred vision, dizziness, headache, nausea, and vomiting
Caution clients about performing activities requiring concen­tration or visual acuity
Serious skin rashes: steven­s-j­ohnsons syndrome
Instruct clients to withhold medica­tions and notify the provider if rash occurs. To minimize the risk of serious rash, the initial dosage should be low and advanced slowly

Contra­ind­ica­tions/ Precau­tions

Carbam­azepine and valproic acid are pregnancy risk category D and can result in birth defects
Lamotr­igine is a pregnancy risk category C, but can cause cleft lip and paleet if taken during the first trimester. Clients should discuss breast­feeding while taking lamotr­igine with the provider
Carbam­azepine is contra­ind­icated in clients who have bone marrow suppre­ssion or bleeding disorders. Clients should avoid breast­feeding
Valproic acid is contra­ind­icated in clients who have liver disorders. Clients of child-­bearing potential should use contra­ception while taking valproic acid
Monitor plasma valproic acid and Carbam­azepine levels while undergoing treatment. The therap­eutic blood level range for Carbam­azepine is 4 to 12 mcg/mL. Therap­eutic blood level range for valproic acid is 50 to 120 mcg/mL.

Compli­cations of Carbam­azepine

Nursing Action and Education
CNS effects: Cognitive function is minimally affected, but CNS effects can include nystagmus, double vision, vertigo, staggering gait, and headaches
Administer low dose initially, then gradually increase dose. Administer dose at bedtime. Avoid driving and other activities that involve alertness at the beginning of treatment. CNS effects should subside within a few weeks
Blood Dyscra­sias: leukop­enia, anemia, thromb­ocy­topenia
Obtain baseline CBC, and platelet, and perform ongoing monito­ring. Observe for indica­tions of bruising and bleeding of gums. Monitor and report sore throat, fatigue, or other indica­tions of infection or bleeding
avoid use in pregnancy
Hypo-o­smo­lality: promotes secretion of ADH, which inhibits water excretion by the kidneys and places clients who have heart failure at risk for fluid overload.
Monitor blood levels of sodium levels. Monitor for edema, decreased urine output, and hypert­ension
Skin disorders: dermat­itis, rash, steven­s-J­ohnson syndrome (which is potent­ially life threat­ening)
Treat mild reactions with anti-i­nfl­amm­atory or antihi­stamine medica­tions. Wear sunscreen. Notify provider if steven­s-j­ohnsons syndrome rash occurs and withhold medication
Hepato­tox­icity: evidenced by anorexia, nausea, vomiting, fatigue, abdominal pain, and jaundice
Assess baseline liver function, and monitor liver function regularly. Avoid using in children under 2. Administer lowest effective dose. observe for indica­tions and notify provider if they occur.

Compli­cations of Valproic Acid

Nursing Action and Education
GI Effects: nausea, vomiting, indige­stion
Manife­sta­tions are usually self-l­imi­ting. Take medica­tions with food or switch to enteric coated pills to reduce GI effects.
Hepato­tox­icity: anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice
Assess liver function, and monitor liver function regularly. Avoid using in children younger than 2. Administer lowest effective dose. Notify provider if they occur.
Pancre­atitis: nausea, vomiting, abdominal pain
Monitor amylase levels. Discon­tinue medication if pancre­atitis develops
monitor platelet counts. Observe for manife­sta­tions (bruising) and notify the provider
Avoid use in pregnancy
Weight Gain
Follow a healthy low calorie diet, engage in regular exercise, and monitor weight

Intera­ctions for Carbam­azepine

Nursing Action and Education
Oral contra­cep­tive, warfarin
Concurrent use causes a decrease in the effects of these medica­tions due to stimul­ation of hepatic metabo­lizing enzymes. Monitor for therap­eutic effects of warfarin. Dosage can be adjusted.
Grapefruit juice: inhibits metabo­lism, thus increasing carbam­azepine levels
avoid intake of grapefruit juice
Phenytoin and phenob­arb­ital: decrease the effects of carbam­azepine by stimul­ating metabolism
Monitor phenytoin and phenob­arbital levels. Adjust dosage of medica­tions as prescribed

Intera­ctions for Lamotr­igine

Nursing Action and Education
Carbam­aze­pine, phenytoin, and phenob­arb­ital: these promote liver drug metabo­lizing enzymes, thereby decreasing the effect of lamotr­igine
Monitor for therap­eutic effects. Adjust dosage of medica­tions as prescribed
Oral contra­cep­tives: Lamotr­igine can reduce progestin levels, estrog­en-­con­taining contra­cep­tives can reduce leveles of lamotr­igine
Lamotr­igine dosage change can be required when beginning or stopping oral contra­ceptive therapy
Valproic Acid: inhibits metabo­lizing and thus increases the half life of lamotringe
Monitor for adverse effects. adjust dosage of medication as prescribed

Intera­ctions of Valproic Acid

Nursing Action and Education
Phenytoin and Phenob­arb­ital: blood levels of these medica­tions are increased when used concur­rently with valproic acid
Monitor phenytoin and phenob­arbital levels. Adjust dosage of medica­tions as prescr­ibed.

Nursing Evaluation of Medication Effect­iveness

Depending on therap­eutic intent, effect­iveness is evidenced by the following
Relief of manife­sta­tions of acute mania (flight of ideas, excessive talking, agitation) or depression (fatigue, poor appetite, psycho­motor retard­ation)
Mood stability
Ability to preform ADLs
Improved sleeping and eating habits
Approp­riate intera­ctions with peers


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