23 Meds Related for Bipolar Disorder Flashcards
valproic acid
for treating + preventing acute mania
valproic acid
monitor what labs?
liver function tests [AST/ALT]
platelet count [150k-300k]
pregnancy test
bipolar is primarily managed with
mood-stabilizing medication
-lithium carbonate
bipolar is treated with..
antiepileptic antipsychotic anxiolytic antidepressants mood stabilizer (primary)
anti-epileptic meds
- valproic acid
- carbamazepine
- lamotrigine
anti-epileptic meds
pharm action
slows entrance of Na + Ca back into neurons
- extends the time it takes for neurons to return to its active state
- incr inhibitory effects of GABA
anti-epileptic inhibits ____ which in turn suppresses ____
glutamate/glutamic acid; CNS excitation
anticonvulsants that act as mood stabilizers
- clonazepam
- gabapentin
- topiramate
med administered for short-term basis for sleep impairment related to mania
lorazepam
do not give ____ while in a manic state.
SSRI
-only for major depressive episode
ANTIPSYCHOTICS
useful in early treatment
- promote sleep
- decr anxiety + agitation
- mood-stabilizing properties
ANXIOLYTIC drugs that are also used for bipolar
clonazepam (also an anticonvulsant) + lorazepam (benzo, sedative)
ANXIOLYTIC
useful in acute mania
-helps manage psychomotor agitation often seen in mania
antidepressants for bipolar + their class
fluoxetine SSRI
bupropion ATYPICAL
venlafaxine SSNRI
____ are prescribed with ____ to prevent rebound mania
antidepressant; mood stabilizer
mood stabilizer
drug name
Lithium carbonate
Lithium carbonate (mood stablzr) pharm action
- serotonin receptor block
- decreases neuronal atrophy
- increases neuronal growth
Lithium carbonate (mood stablzr) indication
- treatment of bipolar
- controls acute mania
- prevents return of mania/depression
- decrease incidence of suicide
Lithium carbonate (mood stablzr) A/E
- GI distress
- fine hand tremors
- polyuria, mild thirst
- wt gain
- renal toxicity
- goiter, hypo-thyroid
- hypotension
- brady-dysrhythmia
- electrolyte imbalance
Lithium carbonate (mood stablzr) GI distress + nursing actions
nausea, diarrhea, ab pain
- usually goes away after long term use
- have w meal or milk
Lithium carbonate (mood stablzr) fine hand tremors + nursing actoins
- can be worsened w stress + caffeine
- admin beta adrenergic blockers (propranolol)
- keep dosage as low as possible, or give divided dosages
- report increased tremors> could be Li toxicity
Lithium carbonate (mood stablzr) polyuria, mild thirst + nursing action
- maintain adeq fluid intake [1.5-3L]
- use K sparing drug (spirolactone)
Lithium carbonate (mood stablzr) renal toxicity + nursing action
- monitor I+O
- adjust dosage, keep as low as possible
- assess baseline BUN + creatinine
- monitor kidney function periodically
Lithium carbonate (mood stablzr) goiter, hypothyroidism + nursing action
- w long term tx
- obtain baseline T3, T4, TSH before tx then annually
- admin levothyroxine
- monitor for signs of hypothyroid
- —cold dry skin, dect hrt rt, wt gain
Lithium carbonate (mood stablzr) hypotension, brady-dysrhythmia, electrolyte imbalance + nursing action
maintain adequate fluid + Na intake
LITHIUM TOXICITY - common a/e
less than 1.5 mEq/L
- diarrhea
- N/V
- thirst
- polyuria
- weakness
- fine hand tremors
- slurred speech
- lethargy
- *manifestations often improve over time
LITHIUM TOXICITY - early indication
1.5-2 mEq/L
- mental confution
- sedation
- poor coordination
- coarse tremors
- contd GI distress (N/V,diarrhea)
- **withold med
- **adjust new dosage based on Li + Na levels
LITHIUM TOXICITY - advanced indication
2-2.5 mEq/L
- extreme polyuria of dilute urine
- tinnitus
- giddiness
- jerky movements
- blured vision
- ataxia
- seizure
- severe hypotension
- stupor>coma
- resp complication> death
- **admin emetic or gastric lavage
_____ may be prescribed during advanced indication of lithium toxicity to increase rate of excretion
- urea
- mannitol
- aminophylline
LITHIUM TOXICITY - severe indication
2.5+ mEq/L
- rapid progression leading to coma/death
* **hemodialysis
Lithium carbonate (mood stablzr) CI
- pregnancy esp 1st trimester
- breastfeeding
- severe renal disease
- severe cardiac disease
- hypovolemia
- schizophrenia
- –caution w thyroid, seizure, diabetes issues
NSAID + Li
incr renal absorption of lithium
>toxicity
Lithium carbonate (mood stablzr) nursing admin
- effects begin 55-7 days
- 2-3x/day bc short half life
- food helps w GI distress
- older adults at risk of toxicity
how often + when should Li levels be obtained?
- monitor Li levels Q2-3days until stable
- —then Q1-2months
- in morning, 10-12 hrs after last dose
Li therapeutic range
acute mania [1-1.5mEq]
maintenance [0.6-1.2]
anti-epileptic meds [valproic acid, carbamazepine, lamotrigine]
indication
- treat + prevent relapse of manic/depress
- esp useful in mixed mania or rapid cycling bipolar
norm AST/ALT, amylase
AST: 0-35 U/L
ALT: 4-36 U/L
amy:40-140 U/L
valproic acid
A/E
- GI effects [n/v, indigestion]
- hepatotoxicity [anorexia, n/v, fatigue, jaundice]
- pancreatitis [n/v, ab pain]
- THROMBOCYTOPENIA
- TERATOGENESIS
- WT GAIN
therapeutic range for valproic acid
50-120 mcg/mL
therapeutic range for carbamazepine
4-12 mcg/mL
