NURS 6630 Week 8 Assignment: Mood Stabilizer

NURS 6630 Week 8 Assignment: Mood Stabilizer – Step-by-Step Guide

The first step before starting to write the NURS 6630 Week 8 Assignment: Mood Stabilizer, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NURS 6630 Week 8 Assignment: Mood Stabilizer

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NURS 6630 Week 8 Assignment: Mood Stabilizer

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NURS 6630 Week 8 Assignment: Mood Stabilizer

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NURS 6630 Week 8 Assignment: Mood Stabilizer

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NURS 6630 Week 8 Assignment: Mood Stabilizer

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NURS 6630 Week 8 Assignment: Mood Stabilizer

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NURS 6630 Week 8 Assignment: Mood Stabilizer Instructions

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. Have a look at NURS 6630 Week 9 Blog: Substance Use, Addiction/Impulse Control Disorder.

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.

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.

By Day 7 of Week 8

Submit by Day 7 of Week 8.

NURS 6630 Week 8 Assignment: Mood Stabilizer Example

Comprehensive Analysis of Traditional Mood Stabilizer Medications: Considerations for Prescribing and Laboratory Monitoring

Carbamazepine

Drugs exert their pharmacological impact via specific biochemical processes known as the mechanism of action. According to Stahl (2021), Carbamazepine, in particular, operates by inhibiting voltage-gated sodium channels, which stabilizes neuronal membranes and reduces excessive neuronal firing. Furthermore, it modulates the release of neurotransmitters, including serotonin and dopamine (Stahl, 2021). These combined mechanisms contribute to carbamazepine’s mood-stabilizing effects.

Foundational Assessment and Laboratory Protocols: Understanding Importance and Frequency of Ongoing Monitoring

Prior to carbamazepine therapy, it is critical to conduct baseline assessments of liver function tests (LFTs), complete blood count (CBC), and renal function. Furthermore, psychiatric symptoms, medical history, and concomitant medications should be thoroughly evaluated. As Grześk et al. (2021) note, continuous monitoring of LFTs, CBC, and renal function is recommended due to the potential risks associated with carbamazepine use, including hepatotoxicity, hematologic abnormalities, and renal impairment. Additionally, given the heightened risk of suicidal thoughts and behaviors, a psychiatric assessment is essential for patients receiving this medication.

For ongoing laboratory assessments, it is recommended to initially monitor LFTs and CBC every two weeks for the first two months, followed by assessments every 3 months thereafter. Renal function should be periodically evaluated, especially in patients with preexisting renal conditions or those taking other nephrotoxic medications (Grześk et al., 2021). Regular monitoring of these laboratory parameters is crucial for promptly identifying and addressing potential adverse effects, thereby optimizing patient outcomes.

Special Population Consideration

Gender-related considerations are crucial due to potential differences in drug metabolism and hormonal influences. In females, carbamazepine dosing adjustments may be necessary during pregnancy or while taking estrogen-containing contraceptives, as interactions and hormonal fluctuations can occur.

In some cases, discontinuing therapy in pregnant women or those attempting pregnancy may be considered if the benefits outweigh the risk of recurrent seizures (Stahl, 2021). Regarding age, dosages must be administered with care in geriatric and pediatric populations due to the potential for toxicity. Additionally, patients with liver diseases require dosage adjustments or close monitoring because of the drug’s liver metabolism, which can lead to increased drug levels and potential toxicity.

FA-Approved Indication

Carbamazepine, an FDA-approved medication, effectively addresses epilepsy by specifically targeting partial and generalized seizures. Furthermore, it is indicated for managing trigeminal neuralgia, a severe facial pain disorder (Stahl, 2021). The approval of carbamazepine for these conditions underscores its efficacy in neurological disorders.

Typical Dosing with Discussion on Therapeutic Endpoints for Psychiatric Use

For bipolar disorder, the initial dose of carbamazepine is kept low to minimize adverse effects, typically around 200 mg per day, divided into two doses. Over several weeks, the dosage is gradually adjusted based on response and tolerability to achieve therapeutic blood levels, with increments usually not exceeding 200 mg per week (Grześk et al., 2021).

The therapeutic goal of using carbamazepine in psychiatric treatment is to stabilize mood symptoms, including reducing manic and depressive episodes. According to Grześk et al. (2021), therapeutic blood levels fall within the range of 4 to 12 μg/mL, which are regularly monitored to ensure both efficacy and safety. Clinical improvement in mood stability, a reduction in mood episodes, and enhanced overall functioning serve as indicators of therapeutic efficacy.

Lamotrigine

Mechanism of Action

Lamotrigine, an antiepileptic drug belonging to the phenyltriazine class, operates by selectively binding to inactivated voltage-sensitive sodium channels. This action inhibits sodium currents, suppressing excitatory neurotransmitter release, including glutamate (Stahl, 2021). By modulating these mechanisms, lamotrigine contributes to its mood-stabilizing properties

Foundational Assessment and Laboratory Protocols: Understanding Importance and Frequency of Ongoing Monitoring

Before starting lamotrigine therapy, assessing baseline LFTs, CBC, and renal function is crucial. Additionally, the patient’s medical history should be considered to rule out cardiovascular issues. Ongoing LFTs, CBC, and renal function monitoring is recommended due to the risk of hepatotoxicity, agranulocytosis, and renal impairment associated with lamotrigine use (Mitra-Ghosh et al., 2020).

Regular assessment for cardiovascular diseases, including performing electrocardiography (ECG), is important. The FDA highlighted an increased risk of arrhythmias for individuals with heart failure who are on lamotrigine treatment (Orts et al., 2023). For ongoing laboratory assessments, it is recommended to initially monitor LFTs and CBC every 2 weeks for the first 2 months, followed by assessments every 3 months thereafter.

Renal function should be periodically evaluated, especially in patients with preexisting renal conditions or those taking other nephrotoxic medications. However, these laboratory assessments can be tailored as needed depending on clinical judgment and patient condition. Regular monitoring of laboratory parameters enables early identification and timely management of potential adverse effects, therefore optimizing patient outcomes.

Special Population Consideration

Studies indicate that gender considerations do not significantly impact the choice of Lamotrigine therapy. However, clinicians should always weigh the benefits versus risks when prescribing Lamotrigine to pregnant women. Age-related differences are important, as pediatric and geriatric populations may metabolize Lamotrigine differently, necessitating dosage adjustments to avoid toxicity (Stahl, 2021). Finally, conditions like hepatic or renal impairment can affect Lamotrigine metabolism and clearance, necessitating dosage modifications or closer monitoring to ensure safety and efficacy.

FDA-Approved Indications, Dosing and Therapeutic Endpoint

Lamotrigine is FDA-approved for several conditions, including bipolar disorder and epilepsy. The initial dosing for both seizure disorder and bipolar disorder is as low as 25 mg once daily. Over several weeks, the dose is carefully titrated based on the patient’s response and tolerability (Stahl, 2021). The primary goal during titration is to minimize the risk of severe rash while achieving therapeutic blood levels associated with mood stabilization or seizure control. Mood stabilization and seizure control mark the therapeutic endpoints for lamotrigine.

Lithium

Mechanism of Action

Lithium lacks fully understood mechanisms for mood regulation. Nevertheless, it is suggested to produce its effects through various pathways, such as blocking post-synaptic D2 receptor hypersensitivity, altering cation transfer in nerve and muscle cells while influencing the reuptake of serotonin or norepinephrine, and inhibiting second messenger systems in the phosphatidylinositol cycle (Rybakowski, 2022). These proposed mechanisms contribute to its ability to stabilize moods, which is crucial in the treatment of mood disorders.

Foundational Assessment and Laboratory Protocols: Understanding Importance and Frequency of Ongoing Monitoring

A comprehensive initial assessment is crucial before starting lithium therapy. This includes tests for renal function, thyroid function (TFTs), electrolyte levels, and an evaluation of psychiatric symptoms, medical history, and any concurrent medications. Given the potential risks of lithium toxicity, renal dysfunction, and thyroid abnormalities associated with lithium use, it is recommended to continuously monitor serum lithium levels, renal function tests, TFTs, and electrolyte levels (Rybakowski, 2022).

Initially, weekly monitoring of serum lithium levels and renal function is advised until therapeutic levels are stable, after which the frequency can be reduced to every 1 to 3 months (Rybakowski, 2022). It is essential to periodically evaluate TFTs and electrolyte levels, particularly in patients more susceptible to thyroid dysfunction or electrolyte disturbances. The importance of regular laboratory parameter monitoring cannot be overstated, as it aids in the detection and management of potential lithium side effects, including lithium toxicity, renal damage, and thyroid dysfunction. Swift recognition of these problems enables immediate action and therapy modification, ultimately improving patient outcomes.

Special Population Consideration

Considerations related to gender are essential due to the potential interactions with hormonal contraceptives containing estrogen, which may influence the effectiveness or heighten the risk of adverse effects in women. Regarding age disparities, both pediatric and elderly populations may process lamotrigine differently, necessitating changes in dosage to guarantee safety and effectiveness. Additional medical conditions, such as liver or kidney dysfunction, can affect the metabolism and elimination of lamotrigine, necessitating adjustments in dosage or more rigorous monitoring to enhance treatment results.

FDA Indications, Dosing and Therapeutic Endpoint

 Lithium is particularly effective in the ongoing treatment of bipolar disorder to avert or delay mood episodes, especially the depressive phase, in adults. Rybakowski (2022) further notes that the usual administration of lithium for mental health purposes involves meticulous titration to reach therapeutic blood concentrations within a restricted range of 0.6 to 1.2 mEq/L. The initial doses are generally low, approximately 300 to 600 mg daily, with gradual increments based on individual reaction and tolerability. The therapeutic endpoint encompasses the prevention of mood swings, with noticeable enhancements in mood stability and overall functioning, signifying the effectiveness of the treatment.

Valproate Products

Mechanism of Action

Valproate derivatives, including valproic acid and sodium valproate, achieve their therapeutic effects through several pathways. These include the amplification of neurotransmission mediated by gamma-aminobutyric acid (GABA) and the suppression of the release of excitatory neurotransmitters (Workman & Tellian, 2021). These mechanisms enable valproate products to exhibit their anticonvulsant and mood-stabilizing properties.

Foundational Assessment and Laboratory Protocols: Understanding Importance and Frequency of Ongoing Monitoring

Before starting valproate treatment, conducting initial assessments that include LFTs, CBC, and serum ammonia levels is important. Due to the risk of hematologic abnormalities, liver toxicity, and high ammonia levels associated with valproate use (Lin et al., 2022), it is recommended to monitor LFTs, CBC, and serum ammonia levels continuously.

In terms of the frequency of ongoing tests and assessments, LFTs and CBC should be checked every 2 weeks for the first 2 months, then every 3 months after that. Serum ammonia levels should be checked from time to time, particularly in patients showing signs of high ammonia levels or liver dysfunction (Lin et al., 2022). Regular monitoring of laboratory parameters is essential to identify and handle potential side effects of valproate, such as liver toxicity and high ammonia levels.

Special Population Considerations

Considerations related to gender are important due to potential interactions with contraceptives that contain estrogen. This may necessitate dosage modifications or increased monitoring, especially in individuals assigned female at birth. Differences related to age are also vital, as children and older adults may need dosage adjustments due to changes in metabolism and clearance associated with age. Other medical conditions, such as liver or kidney dysfunction, require careful dosage and monitoring to reduce the risk of side effects and improve treatment results.

FDA Indications, Dosing and Therapeutic Endpoint

Valproate products have received FDA approval for the management of several conditions, such as bipolar disorder and epilepsy. The usual administration of valproate products for psychiatric purposes involves a slow titration process to reach therapeutic blood concentrations that are associated with mood stabilization or seizure management. The starting doses are typically low; for instance, the initial dose for Valproic acid is generally 10-15 mg/kg per day, with subsequent modifications based on the patient’s response and tolerability (Lin et al., 2022). The therapeutic goals for psychiatric use include the alleviation of manic symptoms and the prevention of mood episodes, as well as the regulation of seizure activity in individuals with epilepsy.

Potential Drug-Drug Interactions

The potential interactions between different psychopharmacological agents require meticulous attention in clinical settings. As Workman and Tellian (2021) reiterate, the combination of Lamotrigine and Valproate might necessitate changes in dosing schedules due to the heightened risk of severe skin reactions, which calls for intensive monitoring and possible adjustments.

As an enzyme inducer, Rifampin could decrease Lamotrigine levels by boosting its metabolism, thereby requiring alterations in dosage and careful monitoring for therapeutic effectiveness and side effects (Workman & Tellian, 2021). Likewise, the use of Valproate in conjunction with birth control containing estrogen could reduce the contraceptive’s effectiveness, leading to the need for alternative contraceptive methods or dosage changes, along with patient education.

The pairing of Valproate and Amitriptyline could increase the risk of central nervous system depression, necessitating careful dosage determination and patient awareness of potential side effects. The interaction between Lithium and Furosemide could lead to lithium toxicity due to increased lithium levels, requiring thorough monitoring and potential dosage modifications (Vaz & Vitória-Silva, 2023).

Similarly, combining Lithium with Lisinopril could result in elevated lithium levels, demanding vigilant monitoring of lithium concentrations and kidney function (Workman & Tellian, 2021). Collaboration with other healthcare professionals, such as internal medicine specialists, may be required for holistic patient care in instances of lithium toxicity.

Combining Carbamazepine and Lurasidone might lower Lurasidone levels, necessitating dosage modifications and intensive monitoring for effectiveness and side effects (Workman & Tellian, 2021). Finally, grapefruit juice inhibits the CYP3A4 liver enzymes, thereby decreasing the liver metabolism of carbamazepine and increasing its bioavailability (Dayyih et al., 2024). The resultant effect of the interaction is the elevation of the levels of carbamazepine, thereby heightening the risk of toxicity.

Ethical, Legal and Social Implications Related to the Prescription of Medications

The process of prescribing medications entails maneuvering through intricate ethical, legal, and societal considerations, especially in situations involving potential drug interactions. For example, when healthcare providers prescribe Lamotrigine and Valproate, they must weigh the clinical advantages of controlling seizures against the heightened risk of severe skin reactions linked to the combination (Workman & Tellian, 2021).

From an ethical standpoint, clinicians must prioritize patient safety by conducting a comprehensive evaluation of the risks and benefits and securing informed consent. From a legal perspective, healthcare providers must comply with prescribing guidelines and vigilantly monitor for side effects to minimize potential damage. On a social level, the prescription of these medications necessitates an understanding of individual patient needs and preferences, as well as a commitment to addressing any disparities in healthcare access that could impact the treatment outcomes.

Likewise, when contemplating the interaction between Valproate and birth control containing estrogen, ethical issues related to patient autonomy and reproductive health come to the fore. It is incumbent upon healthcare providers to ensure that patients are thoroughly informed about the potential decrease in contraceptive efficacy and to engage in discussions about alternative contraception methods (Schoretsanitis et al., 2022). From a legal standpoint, practitioners must follow the principles of informed consent and provide extensive patient education to enable autonomous decision-making.

Socially, the prescription of these medications may intersect with cultural and societal norms related to contraception and reproductive rights, underscoring the significance of culturally sensitive care and advocacy for equal access to reproductive health services. Thus, navigating the ethical, legal, and social ramifications of prescribing medications necessitates thoughtful consideration of individual patient needs, clinical guidelines, and broader social contexts.

References

Dayyih, W. A., Ani, I. A.-, Hailat, M., Alarman, S. M., Zakaraya, Z., Assab, M. A., & Alkhader, E. (2024). Review of grapefruit juice-drugs interactions mediated by intestinal CYP3A4 inhibition. Journal of Applied Pharmaceutical Science. https://doi.org/10.7324/japs.2024.160197

Grześk, G., Stolarek, W., Kasprzak, M., Grześk, E., Rogowicz, D., Wiciński, M., & Krzyżanowski, M. (2021). Therapeutic drug monitoring of carbamazepine: A 20-year observational study. Journal of Clinical Medicine, 10(22), 5396. https://doi.org/10.3390/jcm10225396

Lin, K., Cao, V. F. S., Au, C., & Dahri, K. (2022). Clinical pharmacokinetic monitoring of free valproic acid levels: A systematic review. Clinical Pharmacokinetics, 61(10), 1345–1363. https://doi.org/10.1007/s40262-022-01171-w

Mitra-Ghosh, T., Callisto, S. P., Lamba, J. K., Remmel, R. P., Birnbaum, A. K., Barbarino, J. M., Klein, T. E., & Altman, R. B. (2020). PharmGKB summary: lamotrigine pathway, pharmacokinetics and pharmacodynamics. Pharmacogenetics and Genomics, 30(4), 81–90. https://doi.org/10.1097/fpc.0000000000000397

Orts, L., Flumian, C., & Montastruc, F. (2023). Lamotrigine and risk of arrhythmias: A global pharmacovigilance analysis. Journal of the Neurological Sciences, 448(120644), 120644. https://doi.org/10.1016/j.jns.2023.120644

Rybakowski, J. K. (2022). Mood Stabilizers: Lithium. In NeuroPsychopharmacotherapy (pp. 1493–1521). Springer International Publishing. https://doi.org/10.1007/978-3-030-62059-2_45

Schoretsanitis, G., Deligiannidis, K. M., Paulzen, M., Spina, E., & de Leon, J. (2022). Drug-drug interactions between psychotropic medications and oral contraceptives. Expert Opinion on Drug Metabolism & Toxicology, 18(6), 395–411. https://doi.org/10.1080/17425255.2022.2106214

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications. Cambridge University Press.

Vaz, I., & Vitória-Silva, J. (2023). Lithium intoxication due to furosemide interaction – a case report. European Psychiatry: The Journal of the Association of European Psychiatrists, 66(S1), S699–S700. https://doi.org/10.1192/j.eurpsy.2023.1464

Workman, E. A., & Tellian, F. F. (2021). Practical handbook of psychopharmacology: A clinician’s guide. CRC Press.