1. By the Mood Swingers Group 1

2. Indicators for Use of Lithium Manic depressive Psychoses Schizoaffective illness.

3. Adverse Effects of Lithium Side effects of lithium include: Nausea & vomiting diarrhoea abdominal pain muscle weakness Thirst polyuria tremor Weight gain Signs of toxicity include: ataxia, muscle twitching coarse tremor and muscle weakness. This may progress to; drowsiness, disorientation, hypertonicity, hyperreflexia, fasciculations, convulsions and coma. Dementia, focal neurological deficits or death may ensue.

4. Contraindications/ Precautions Toxicity may develop because of: excessive intake dehydration and poor salt intake renal impairment deliberate over-dosage or due to a drug-drug interaction with medications such as; diuretics and NSAIDs. Not to prescribe during pregnancy due to side effects

5. Nursing Implications Give during or after meals to decrease GI irritation Monitor serum levels at least 2 weekly to stabilise manic episodes after stabilisation every month Observe for decrease in manic behaviour and mood swings and drug interactions Diuretics and anti inflammatory increase the effect of lithium Avoid lithium toxicity check Electrolyte levels TSH T4, LFTs routinely

6. Carbamazepine Uses For anticonvulsant medication Grand mal and partial Seizures Blocks certain responses in the brain Trigeminal neuralgia Bipolar Disorder Reduces anxiety irritability elation Impulse control behaviour

7. Adverse Effects Low WBC and Red blood cell count Liver abnormalities such as jaundice Thyroid abnormalities Dizziness, Nausea, Vomiting, Unsteadiness Increased risk of suicidal thinking and behaviours photosensitivity reactions. CNS: headache, tremors, confusion, restlessness, memory loss, seizures, slurred speech, muscle weakness, lack of coordination, lethargy, stupor CV: bradycardia, ECG changes, arrhythmias, hypotension, peripheral circulatory collapse EENT: blurred vision, tinnitus GI: anorexia,, abdominal cramps or pain, diarrhoea, dry mouth, extreme thirst, metallic taste, weight gain GU: polyuria, glycosuria, proteinuria, incontinence, oedema, hyponatremia Hematologic: leukocytosis Skin: rash, pruritus, alopecia, sweating, dryness or thinning of hair

8. Precaution/ Contraindications Interacts with multiple drugs precautions should be taken when combining other medications These include: Phenytoin Primidone Warfarin Theophylline Valproic Acid Erythronycin Cimetidine Propoxyphine Calcium Channel Blockers Birth control pills Should not be used in pregnancy and breast feeding.

9. Nursing implications Take with food Instruct patient to take carbamazepine around the clock, exactly as directed. Advise patient not to take alcohol or other CNS depressant concurrently with this medication. Apply sunscreen and wear sun smart clothing, U.V approved eye wear Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum or lollies may help reduce dry mouth. Saliva substitute may be used.

10. Sodium Valproate Anticonvulsant Antipsychotic Mania

11. Adverse effects Haematological Neurological Liver dysfunction Hyperammonaemia Pancreatitis GI Upset Platelet dysfunction Skin reactions Hair loss Oedema Weight gain

12. Precaution/ Contradictions Pre existing liver dysfunction Family history of Severe hepatitis Urea cycle disorders Pregnancy Impaired renal function Abrupt Withdrawal Diabetes Thrombocytopenia Platelet levels Children Kidney disease Congenital Metabolic disorders HIV Organic brain disorders

13. Nursing Implications Monitor patient alertness Evaluate plasma levels for toxicity Baseline platelet count Serum levels LFT UEC FBC Do not discontinue medication suddenly Notify DR if spontaneous bleeding occurs

14. Indicators of use for Olanzapine Antipsychotic Antimanic Mood stabiliser disabling high and low extremes of mood associated with bipolar I disorder. is used to treat symptoms of schizophrenia related psychoses. Dementia

15. Adverse effects Hypertension Weight gain Peripheral oedema Precipitate type 2 diabetes Cardiovascular disease Severe CNS depression Lactation Narrow angle glaucoma Transient elevation of liver enzymes Drowsiness/ dizziness GI upset Constipation Fever Weight gain Joint pain Tachycardia Bone marrow depletion Cough and pharyngitis

16. Precautions/Contraindications Allergies to olanzapine Myeloproliferative disorder Lactation Cardiovascular disease Diabetes Prostate enlargement Breast cancer pregnancy Reacts with Other Drugs

17. Nursing implications Do not dispense more than 1 weeks supply at a time Drug interaction Monitor for dehydration Monitor for sedation and decreased sensation Urinary retention Temperature Hypertension Take directly as prescribed Take within 1 hour window of prescribed time