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ATI Mental Health > 23 Meds Related for Bipolar Disorder > Flashcards

23 Meds Related for Bipolar Disorder Flashcards

1
Q

valproic acid

A

for treating + preventing acute mania

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2
Q

valproic acid

monitor what labs?

A

liver function tests [AST/ALT]
platelet count [150k-300k]
pregnancy test

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3
Q

bipolar is primarily managed with

A

mood-stabilizing medication

-lithium carbonate

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4
Q

bipolar is treated with..

A 
antiepileptic
antipsychotic
anxiolytic
antidepressants
mood stabilizer (primary)
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5
Q

anti-epileptic meds

A
  • valproic acid
  • carbamazepine
  • lamotrigine
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6
Q

anti-epileptic meds

pharm action

A

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
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7
Q

anti-epileptic inhibits ____ which in turn suppresses ____

A

glutamate/glutamic acid; CNS excitation

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8
Q

anticonvulsants that act as mood stabilizers

A
  • clonazepam
  • gabapentin
  • topiramate
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9
Q

med administered for short-term basis for sleep impairment related to mania

A

lorazepam

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10
Q

do not give ____ while in a manic state.

A

SSRI

-only for major depressive episode

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11
Q

ANTIPSYCHOTICS

A

useful in early treatment

  • promote sleep
  • decr anxiety + agitation
  • mood-stabilizing properties
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12
Q

ANXIOLYTIC drugs that are also used for bipolar

A

clonazepam (also an anticonvulsant) + lorazepam (benzo, sedative)

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13
Q

ANXIOLYTIC

A

useful in acute mania

-helps manage psychomotor agitation often seen in mania

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14
Q

antidepressants for bipolar + their class

A

fluoxetine SSRI
bupropion ATYPICAL
venlafaxine SSNRI

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15
Q

____ are prescribed with ____ to prevent rebound mania

A

antidepressant; mood stabilizer

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16
Q

mood stabilizer

drug name

A

Lithium carbonate

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17
Q 
Lithium carbonate (mood stablzr)
pharm action
A
  • serotonin receptor block
  • decreases neuronal atrophy
  • increases neuronal growth
18
Q 
Lithium carbonate (mood stablzr)
indication
A
  • treatment of bipolar
  • controls acute mania
  • prevents return of mania/depression
  • decrease incidence of suicide
19
Q 
Lithium carbonate (mood stablzr)
A/E
A
  • GI distress
  • fine hand tremors
  • polyuria, mild thirst
  • wt gain
  • renal toxicity
  • goiter, hypo-thyroid
  • hypotension
  • brady-dysrhythmia
  • electrolyte imbalance
20
Q 
Lithium carbonate (mood stablzr)
GI distress + nursing actions
A

nausea, diarrhea, ab pain

  • usually goes away after long term use
  • have w meal or milk
21
Q 
Lithium carbonate (mood stablzr)
fine hand tremors + nursing actoins
A
  • 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
22
Q 
Lithium carbonate (mood stablzr)
polyuria, mild thirst + nursing action
A
  • maintain adeq fluid intake [1.5-3L]

- use K sparing drug (spirolactone)

23
Q 
Lithium carbonate (mood stablzr)
renal toxicity + nursing action
A
  • monitor I+O
  • adjust dosage, keep as low as possible
  • assess baseline BUN + creatinine
  • monitor kidney function periodically
24
Q 
Lithium carbonate (mood stablzr)
goiter, hypothyroidism + nursing action
A
  • 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
25
Q 
Lithium carbonate (mood stablzr)
hypotension, brady-dysrhythmia, electrolyte imbalance + nursing action
A

maintain adequate fluid + Na intake

26
Q

LITHIUM TOXICITY - common a/e

less than 1.5 mEq/L

A
  • diarrhea
  • N/V
  • thirst
  • polyuria
  • weakness
  • fine hand tremors
  • slurred speech
  • lethargy
  • *manifestations often improve over time
27
Q

LITHIUM TOXICITY - early indication

1.5-2 mEq/L

A
  • mental confution
  • sedation
  • poor coordination
  • coarse tremors
  • contd GI distress (N/V,diarrhea)
  • **withold med
  • **adjust new dosage based on Li + Na levels
28
Q

LITHIUM TOXICITY - advanced indication

2-2.5 mEq/L

A
  • 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
29
Q

_____ may be prescribed during advanced indication of lithium toxicity to increase rate of excretion

A
  • urea
  • mannitol
  • aminophylline
30
Q

LITHIUM TOXICITY - severe indication

2.5+ mEq/L

A
  • rapid progression leading to coma/death

* **hemodialysis

31
Q 
Lithium carbonate (mood stablzr)
CI
A
  • pregnancy esp 1st trimester
  • breastfeeding
  • severe renal disease
  • severe cardiac disease
  • hypovolemia
  • schizophrenia
  • –caution w thyroid, seizure, diabetes issues
32
Q

NSAID + Li

A

incr renal absorption of lithium

>toxicity

33
Q 
Lithium carbonate (mood stablzr)
nursing admin
A
  • effects begin 55-7 days
  • 2-3x/day bc short half life
  • food helps w GI distress
  • older adults at risk of toxicity
34
Q

how often + when should Li levels be obtained?

A
  • monitor Li levels Q2-3days until stable
  • —then Q1-2months
  • in morning, 10-12 hrs after last dose
35
Q

Li therapeutic range

A

acute mania [1-1.5mEq]

maintenance [0.6-1.2]

36
Q

anti-epileptic meds [valproic acid, carbamazepine, lamotrigine]
indication

A
  • treat + prevent relapse of manic/depress

- esp useful in mixed mania or rapid cycling bipolar

37
Q

norm AST/ALT, amylase

A

AST: 0-35 U/L
ALT: 4-36 U/L

amy:40-140 U/L

38
Q

valproic acid

A/E

A
  • GI effects [n/v, indigestion]
  • hepatotoxicity [anorexia, n/v, fatigue, jaundice]
  • pancreatitis [n/v, ab pain]
  • THROMBOCYTOPENIA
  • TERATOGENESIS
  • WT GAIN
39
Q

therapeutic range for valproic acid

A

50-120 mcg/mL

40
Q

therapeutic range for carbamazepine

A

4-12 mcg/mL

ATI Mental Health (22 decks)

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