ATI Ch 14, Bipolar Disorders Flashcards
1
Q
What are bipolar disorders?
A
Mood disorders with recurrent episodes of depression and mania
2
Q
When do bipolar disorders usually emerge?
A
In early adulthood
3
Q
Can bipolar disorder be diagnosed in pediatric clients?
A
Yes, early-onset bipolar disorder can be diagnosed in pediatric clients
4
Q
Why is it more difficult to assess and diagnose bipolar disorders in children?
A
Because manifestations can mimic expected findings of attention deficit hyperactivity disorder (ADHD)
5
Q
What alternates with periods of illness in bipolar disorder?
A
Periods of normal functioning
6
Q
What behaviors can clients exhibit during periods of mania?
A
Psychotic, paranoid, and/or bizarre behavior
7
Q
What are the goals of treatment during the acute phase of bipolar disorder?
A
Reduction of mania and client safety
8
Q
What may be required for a client during the acute phase of bipolar disorder?
A
Hospitalization
9
Q
What is determined regarding risk during the acute phase?
A
Risk of harm to self or others
10
Q
What type of supervision can be indicated for client safety?
A
One-to-one supervision
11
Q
How long does treatment generally last during the continuation phase?
A
4 to 9 months
12
Q
What is the goal of treatment during the maintenance phase?
A
Prevention of future manic episodes
13
Q
Fill in the blank: Bipolar disorders are mood disorders with recurrent episodes of _______.
A
[depression and mania]
14
Q
What is mania?
A
An abnormally elevated mood, can be expansive or irritable, usually requires hospitalization, lasts at least 1 week.
Manic episodes are characterized by significant impairment in social or occupational functioning.
15
Q
What is hypomania?
A
A less severe episode of mania lasting at least 4 days, accompanied by three or more manifestations of mania, does not require hospitalization.
Hypomania can progress to mania.
16
Q
Define rapid cycling in bipolar disorder.
A
Four or more episodes of hypomania or acute mania within 1 year, associated with increased recurrence rate and resistance to treatment.
Rapid cycling is a specifier for bipolar disorders.
17
Q
What characterizes Bipolar I disorder?
A
At least one episode of mania alternating with major depression.
Bipolar I disorder often leads to severe functional impairment.
18
Q
What defines Bipolar II disorder?
A
One or more hypomanic episodes alternating with major depressive episodes.
Bipolar II disorder may be less severe than Bipolar I but still significantly impacts life.
19
Q
What is cyclothymic disorder?
A
At least 2 years of repeated hypomanic manifestations that do not meet criteria for hypomanic episodes alternating with minor depressive episodes.
Cyclothymic disorder is considered a milder form of bipolar disorder.
20
Q
List some comorbidities associated with bipolar disorder.
A
- Substance use disorder
- Anxiety disorders
- Borderline personality disorder
- Oppositional defiant disorder
- Social phobia and specific phobias
- Seasonal affective disorder
- Attention deficit hyperactivity disorder
- Migraines
- Metabolic syndrome
Comorbidities can complicate the treatment and management of bipolar disorder.
21
Q
What genetic factor increases the risk of developing bipolar disorder?
A
Having an immediate family member who has a bipolar disorder.
Genetics plays a significant role in the risk of developing bipolar disorder.
22
Q
What physiological factors are risk factors for bipolar disorder?
A
Neurobiologic and neuroendocrine disorders.
These physiological factors can affect mood regulation.
23
Q
What environmental factors can trigger mania and depression?
A
Increased stress in the environment can trigger mania and depression, increasing risk for severe manifestations in genetically-susceptible children.
Environmental stressors may include life changes, trauma, or chronic stress.
24
Q
Fill in the blank: Use of substances such as _______ can lead to an episode of mania.
A
alcohol, cocaine, caffeine
Substance use is a significant trigger for manic episodes.
25
True or False: Sleep disturbances can precede, be associated with, or be triggered by an episode of mania.
True.
## Footnote
Sleep patterns are often disrupted during manic episodes.
26
What psychological factors can trigger an episode of mania?
Psychological stressors.
## Footnote
Stressful life events or ongoing psychological strain can precipitate manic episodes.
27
28
What are the labile mood characteristics of mania?
Labile mood with euphoria
## Footnote
Mood changes rapidly between extremes
29
List three common manic characteristics.
* Agitation and irritability
* Restlessness
* Impulsivity
30
What is 'flight of ideas'?
Rapid, continuous speech with sudden and frequent topic change
## Footnote
A hallmark of manic episodes
31
Define grandiosity in the context of mania.
Grandiose view of self and abilities
## Footnote
An inflated sense of self-importance
32
What behavior might indicate impulsivity in a manic episode?
Spending money, giving away money or possessions
## Footnote
Impulsive actions often lead to regret
33
What is a key feature of attention during a manic episode?
Distractibility and decreased attention span
## Footnote
Difficulty focusing on tasks
34
True or False: Individuals in a manic episode often show poor judgment.
True
35
What are two depressive characteristics?
* Flat, blunted, labile affect
* Anhedonia
36
What does anhedonia mean?
Loss of pleasure and lack of interest in activities, hobbies, sexual activity
## Footnote
A common symptom of depression
37
What is the Altman Self Rating Mania Scale (ASRM)?
A standardized tool that assesses the client's placement on the continuum from depression to mania
## Footnote
Useful for management and treatment
38
What is the focus of nursing care during an acute manic episode?
Safety and maintaining physical health
## Footnote
Essential for client stability
39
What should be provided in a therapeutic milieu during an acute phase?
A safe environment
## Footnote
Critical for managing behavior
40
How should a nurse manage client stimulation during a manic episode?
Decrease stimulation without isolating the client if possible
## Footnote
Consider environmental factors like noise
41
What might be necessary if a client's behavior escalates?
Seclusion
## Footnote
May be the only safe option in certain cases
42
What should be followed for client protection if there is a threat of self-injury or injury to others?
Agency protocols (restraints, seclusion, one-to-one observation)
## Footnote
These protocols are essential for ensuring safety in high-risk situations.
43
What is recommended to implement for clients to ensure well-being?
Frequent rest periods
## Footnote
These help to manage fatigue and promote mental health.
44
What type of activities should clients be provided with?
Outlets for physical activity
## Footnote
Physical activity can improve mood and reduce anxiety.
45
What types of activities should be avoided for clients?
Activities that last a long time or require a high level of concentration and/or detailed instructions
## Footnote
These can overwhelm clients and lead to frustration.
46
What behaviors should clients be protected from?
Poor judgment and impulsive behavior
## Footnote
Examples include giving money away and sexual indiscretions.
47
What are some self-care needs that should be monitored?
Sleep, fluid intake, and nutrition
## Footnote
These are crucial for maintaining overall health.
48
What type of food should be provided to clients?
Portable, nutritious food
## Footnote
This is important as clients may not be able to sit down to eat.
49
What should be supervised regarding the client's appearance?
Choice of clothes
## Footnote
This promotes autonomy while ensuring appropriateness.
50
What should be given to clients for hygiene and dress?
Step-by-step reminders
## Footnote
These assist clients who may struggle with memory or organization.
51
What type of approach should be used in communication with clients?
Calm, matter-of-fact, specific approach
## Footnote
This helps to reduce anxiety and clarify expectations.
52
What type of explanations should be provided to clients?
Concise explanations
## Footnote
This aids in understanding and reduces confusion.
53
What should be ensured with expectations and limit-setting?
Consistency
## Footnote
Consistency helps clients feel secure and understand boundaries.
54
What should be avoided to maintain a positive interaction with clients?
Power struggles
## Footnote
Engaging in power struggles can escalate conflicts.
55
How should one react to the client's comments?
Do not react personally
## Footnote
This helps maintain professionalism and reduces emotional escalation.
56
What should be done regarding legitimate client grievances?
Listen to and act on them
## Footnote
Addressing grievances can improve trust and rapport.
57
What behaviors should be reinforced in clients?
Nonmanipulative behaviors
## Footnote
Positive reinforcement encourages healthy interactions.
58
What techniques should be used in communication?
Therapeutic communication techniques
## Footnote
These techniques facilitate understanding and emotional support.
59
What is Electroconvulsive therapy (ECT) used for?
Moderate extreme manic behavior and benefit clients who are suicidal or have rapid cycling
## Footnote
ECT is particularly useful when pharmacological therapy, such as lithium, has not been effective.
60
What are potential complications of a client in a true manic state?
Physical exhaustion and possible death
## Footnote
Clients may not stop moving, eat, drink, or sleep, leading to medical emergencies.
61
List some nursing actions for managing a client in a manic state.
* Prevent client self-harm
* Decrease client's physical activity
* Ensure adequate fluid and food intake
* Promote an adequate amount of sleep each night
* Assist the client with self-care needs
* Manage medication appropriately
## Footnote
These actions are crucial for the safety and well-being of the client.
62
What is included in client education for manic clients?
* Case management for follow-up
* Group, family, and individual psychotherapy (cognitive-behavior therapy) to improve problem-solving and interpersonal skills
## Footnote
Education focuses on ongoing support and coping strategies.
63
What chronicity aspect is important for health teaching?
The disorder requires long-term pharmacological and psychological support
## Footnote
This emphasizes the need for ongoing treatment and monitoring.
64
What are some benefits of psychotherapy and support groups?
Prevent relapse
## Footnote
Psychotherapy and support groups provide essential coping mechanisms and emotional support.
65
What should clients be educated about regarding relapse?
* Indications of impending relapse
* Ways to manage the crisis
* Precipitating factors of relapse (sleep disturbance, use of alcohol or caffeine)
## Footnote
Understanding these factors can help clients avoid triggers and manage their condition effectively.
66
What is the importance of maintaining a regular sleep, meal, and activity pattern?
Helps prevent relapse
## Footnote
Consistency in these areas is crucial for stability in mood disorders.
67
What is the prototype medication for mood stabilization?
Lithium carbonate
## Footnote
Lithium is the primary medication used for treating bipolar disorder.
68
What are the expected pharmacological actions of Lithium?
* Produces neurochemical changes in the brain
* Includes serotonin receptor blockade
* Decreases neuronal atrophy and/or increases neuronal growth
## Footnote
These actions contribute to mood stabilization and overall brain health.
69
What are the therapeutic uses of Lithium?
* Treatment of bipolar disorders
* Controls episodes of acute mania
* Helps prevent return of mania or depression
* Decreases incidence of suicide
## Footnote
Lithium is a critical component in managing bipolar disorder and reducing suicidal tendencies.
70
What are common gastrointestinal adverse effects of Lithium medication?
Nausea, diarrhea, abdominal pain
## Footnote
These effects usually resolve within a few weeks of starting the Lithium medication.
71
What nursing action should be taken for gastrointestinal distress while taking Lithium?
Administer Lithium medication with meals or milk
## Footnote
This can help minimize GI distress.
72
What are fine hand tremors and what factors can exacerbate them while taking Lithium?
Fine hand tremors can interfere with purposeful motor skills and can be exacerbated by stress and caffeine
## Footnote
They may indicate lithium toxicity if they increase.
73
What nursing actions should be taken for fine hand tremors while taking Lithium?
* Administer beta-adrenergic blocking agents (propranolol)
* Adjust lithium dosage to the lowest possible level
* Advise client to report an increase in tremors
74
What is a recommended nursing action for polyuria and mild thirst while taking Lithium?
Use a potassium-sparing diuretic (spironolactone)
## Footnote
This helps manage symptoms related to fluid balance while taking Lithium.
75
What client education is important for managing polyuria while taking Lithium?
Maintain adequate fluid intake by consuming at least 1.5 to 3 L/day
## Footnote
This includes beverages and food sources.
76
What nursing actions should be taken to manage weight gain while taking Lithium?
Assist the client to follow a healthy diet and regular exercise regimen
## Footnote
Lifestyle changes are essential for managing weight.
77
What nursing actions are necessary to monitor for renal toxicity for Lithium treatment?
* Monitor I&O
* Adjust dosage to the lowest necessary level
* Assess baseline BUN and creatinine, and monitor kidney function periodically
78
What complications can arise from long-term Lithium treatment related to thyroid function?
Goiter and hypothyroidism
## Footnote
Regular monitoring of thyroid levels is crucial.
79
What nursing actions should be taken for thyroid function monitoring before taking Lithium?
* Obtain baseline T3, T4, and TSH levels prior to starting treatment
* Monitor these levels annually
* Administer levothyroxine if necessary
80
What client education should be provided regarding hypothyroidism?
Monitor for indications such as cold, dry skin; decreased heart rate; weight gain
## Footnote
These symptoms are important to recognize early and can occur from long term lithium treatment
81
What are potential cardiovascular complications associated with lithium medication?
Bradydysrhythmias, hypotension, and electrolyte imbalances
## Footnote
These can have serious implications for patient health taking Lithium.
82
What client education is essential for managing bradydysrhythmias and hypotension?
Maintain adequate fluid and sodium intake
## Footnote
This helps prevent complications related to electrolyte imbalances while taking lithium.
83
What is the lithium level indicating common adverse effects?
Less than 1.5 mEq/L
## Footnote
Common adverse effects include diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, fine hand tremors, slurred speech, and lethargy.
84
What nursing actions should be taken for common adverse effects of lithium?
Instruct the client that manifestations at low levels often improve over time.
## Footnote
Early intervention can help manage symptoms effectively.
85
What lithium level indicates early indications of toxicity?
1.5 to 2.0 mEq/L
## Footnote
Early indications include mental confusion, sedation, poor coordination, coarse tremors, and ongoing GI distress.
86
What nursing actions should be taken for early indications of lithium toxicity?
Withhold the medication and notify the provider; administer new dosage based on blood lithium and sodium levels.
## Footnote
Promoting excretion may also be necessary.
87
What is the lithium level indicating advanced indications of toxicity?
2.0 to 2.5 mEq/L
## Footnote
Advanced indications include extreme polyuria, tinnitus, giddiness, jerking movements, blurred vision, ataxia, seizures, and severe hypotension.
88
What nursing actions should be taken for advanced indications of lithium toxicity?
Administer an emetic or gastric lavage; prescribe urea, mannitol, or aminophylline to increase excretion.
## Footnote
These actions help to manage severe symptoms and prevent progression.
89
What lithium level indicates severe toxicity?
Greater than 2.5 mEq/L
## Footnote
Severe toxicity can lead to rapid progression of symptoms, coma, and death.
90
What nursing actions are warranted for severe lithium toxicity?
Hemodialysis can be warranted.
## Footnote
This is a critical intervention for severe cases.
91
What is the pregnancy risk category of lithium?
Category D
## Footnote
Lithium is considered teratogenic, especially during the first trimester.
92
What precautions should be taken regarding breastfeeding during lithium therapy?
Discourage clients from breastfeeding if lithium therapy is necessary.
## Footnote
This is to prevent potential harm to the infant.
93
In which conditions is lithium contraindicated?
Severe renal or cardiac disease, hypovolemia, and schizophrenia.
## Footnote
These conditions can exacerbate the effects of lithium.
94
What precautions should be observed when prescribing lithium to older adults?
Use cautiously in older adult clients and those with thyroid disease, seizure disorder, or diabetes.
## Footnote
These populations may have increased sensitivity to lithium.
95
What is the effect of diuretics on sodium excretion?
Sodium is excreted with the use of diuretics
## Footnote
This can lead to decreased blood sodium levels and decreased lithium excretion, increasing the risk of toxicity.
96
What should be monitored to prevent lithium toxicity when using diuretics?
Monitor for indications of toxicity
## Footnote
Also, maintain a diet adequate in sodium and drink 1.5 to 3 L/day of water.
97
What is the effect of NSAIDs on lithium levels?
Concurrent use increases renal reabsorption of lithium, leading to toxicity
## Footnote
Aspirin can be used as a mild analgesic without leading to toxicity.
98
What should be avoided to prevent lithium toxicity?
Avoid use of NSAIDs
## Footnote
This prevents toxic accumulation of lithium.
99
What type of medications can cause abdominal discomfort due to urinary retention?
Anticholinergics (antihistamines, tricyclic antidepressants)
## Footnote
These can lead to polyuria as well.
100
What client education is necessary regarding anticholinergic medications?
Avoid medications that have anticholinergic effects
## Footnote
This is important to prevent complications.
101
How often should lithium plasma levels be monitored during treatment initiation?
Every 2 to 3 days until stable
## Footnote
After stabilization, monitor every 1 to 3 months.
102
When should lithium blood levels be obtained?
In the morning, 10 to 12 hours after the last dose
## Footnote
This timing helps ensure accurate measurements.
103
What is the required lithium level during the initial treatment of a manic episode?
1 to 1.5 mEq/L
## Footnote
This is higher than the maintenance level.
104
What is the maintenance level range for lithium?
0.6 to 1.2 mEq/L
## Footnote
This range helps to manage the condition effectively.
105
Why are older adult clients at increased risk regarding lithium?
They require more frequent monitoring of blood levels
## Footnote
This is due to an increased risk for toxicity.
106
What is indicated for clients with advanced or severe lithium toxicity?
Care should take place in an acute care setting
## Footnote
Supportive measures are necessary, and hemodialysis may be indicated.
107
How long does it take for lithium effects to begin?
Effects begin within 5 to 7 days
## Footnote
Maximum benefits might not be seen for 2 to 3 weeks.
108
How should lithium be administered to decrease GI distress?
In 2 to 3 doses daily
## Footnote
Taking lithium with food can also help decrease GI distress.
109
What should clients be encouraged to adhere to for monitoring lithium effectiveness?
Laboratory appointments needed to monitor lithium effectiveness and adverse effects
## Footnote
Emphasize the risk of toxicity is high due to the narrow therapeutic range.
110
What nutritional counseling should be provided to clients on lithium?
Adequate fluid and sodium intake
## Footnote
Stress the importance of these dietary considerations.
111
What should clients monitor for indications of lithium toxicity?
Diarrhea, vomiting, or excessive sweating
## Footnote
Clients should withhold the medication and seek medical attention if experiencing these symptoms.
112
Name three mood-stabilizing antiepileptic medications.
* Carbamazepine
* Valproate
* Lamotrigine
113
What is the purpose of antiepileptic medications in bipolar disorder?
Help treat and manage bipolar disorder through various mechanisms
## Footnote
This includes slowing sodium and calcium entrance into neurons.
114
What pharmacological action does carbamazepine have?
Slowing the entrance of sodium and calcium back into the neuron
## Footnote
This extends the time it takes for the nerve to return to its active state.
115
How do antiepileptic medications potentiate their effects?
By potentiating the inhibitory effects of gamma butyric acid (GABA)
## Footnote
This helps in managing mood stabilization.
116
What is the expected action of antiepileptic medications regarding glutamic acid?
Inhibiting glutamic acid (glutamate)
## Footnote
This suppression helps reduce central nervous system excitation.
117
What are the therapeutic uses of mood-stabilizing antiepileptic medications?
Treat and prevent relapse of manic and depressive episodes
## Footnote
Particularly useful for clients with mixed mania and rapid-cycling bipolar disorders.
118
What are some complications associated with carbamazepine?
* Minimal effect on cognitive function
* Nystagmus
* Double vision
* Vertigo
* Staggering gait
* Headache
119
120
What is the initial dosage administration guideline for Carbamazepine?
Administer in low doses initially, and then gradually increase dosage.
121
When should Carbamazepine be administered?
Administer dose at bedtime.
122
How long should it take for the effects of Carbamazepine to subside?
Effects should subside within a few weeks.
123
What blood dyscrasias are associated with Carbamazepine?
* Leukopenia
* Anemia
* Thrombocytopenia
124
What nursing actions should be taken regarding blood counts for a patient on Carbamazepine?
Obtain baseline CBC and platelets. Perform ongoing monitoring of these.
125
What are the indications of thrombocytopenia to observe for in a patient taking Carbamazepine?
* Bruising
* Bleeding of gums
126
What signs should be monitored for infection in patients on Carbamazepine?
* Fever
* Lethargy
127
What client education should be provided regarding blood dyscrasias when taking Carbamazepine?
Notify the provider if indications of blood dyscrasias are present.
128
What is the recommendation regarding Carbamazepine use in pregnancy?
Avoid use in pregnancy.
129
What condition is caused by Carbamazepine's promotion of antidiuretic hormone secretion?
Hypo-osmolarity
130
What nursing actions should be taken to monitor for hypo-osmolarity in patients with heart failure using Carbamazepine?
* Monitor blood sodium
* Monitor for edema
* Monitor for decrease in urine output
* Monitor for hypertension
131
What skin disorders may occur with Carbamazepine use?
Includes dermatitis and rash (Stevens-Johnson syndrome).
132
What nursing action should be taken for mild skin reactions to Carbamazepine?
Treat mild reactions with anti-inflammatory or antihistamine medications.
133
What client education should be provided if Stevens-Johnson syndrome occurs while taking Carbamazepine?
Withhold the medication and notify the provider.
134
What preventive measure should be taken to reduce the chance of skin disorders when using Carbamazepine?
Wear sunscreen.
135
What side effects are associated with Lamotrigine?
* Double or blurred vision
* Dizziness
* Headache
* Nausea
* Vomiting
136
What client education should be provided regarding activities while taking Lamotrigine?
Avoid performing activities that require concentration or visual acuity.
137
What serious skin condition is associated with Lamotrigine?
Includes Stevens-Johnson syndrome.
138
What should a patient do if a rash occurs while taking Lamotrigine?
Withhold the medication and notify the provider.
139
What is the recommended dosage adjustment strategy for Lamotrigine to minimize serious rash risk?
Start with a low dose and slowly increase it.
140
What are common gastrointestinal effects of Valproate?
Nausea, vomiting, indigestion
## Footnote
These effects are generally self-limiting.
141
How can gastrointestinal effects of Valproate be mitigated?
Take medication with food or switch to enteric-coated formulations
## Footnote
This can help reduce nausea and other GI effects.
142
What are signs of hepatotoxicity related to Valproate?
Anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice
## Footnote
Monitor for these symptoms to detect liver issues.
143
What nursing actions should be taken regarding liver function when administering Valproate?
Assess baseline liver function and monitor liver function regularly (minimum of every 2 months during the first 6 months of treatment)
## Footnote
Regular monitoring is crucial to prevent hepatotoxicity.
144
What is the age restriction for using Valproate?
Avoid using in children younger than 2 years old
## Footnote
This is due to safety concerns.
145
What is the recommended dosing strategy for Valproate?
Administer the lowest effective dose
## Footnote
This helps minimize side effects.
146
What should clients be educated to observe for regarding hepatotoxicity?
Indications of hepatotoxicity and notify the provider immediately if they occur
## Footnote
Early detection can prevent severe liver damage.
147
What are signs of pancreatitis related to Valproate use?
Nausea, vomiting, abdominal pain
## Footnote
These symptoms necessitate further evaluation.
148
What nursing actions are recommended if pancreatitis develops in a patient taking Valproate?
Monitor amylase levels and discontinue the medication if pancreatitis develops
## Footnote
Monitoring amylase can help in diagnosing pancreatitis.
149
What should clients observe for regarding thrombocytopenia while on Valproate?
Indications like bruising and notify the provider if these occur
## Footnote
Thrombocytopenia can lead to serious bleeding issues.
150
What nursing action should be taken regarding platelet counts for patients on Valproate?
Monitor platelet counts
## Footnote
Regular monitoring helps detect thrombocytopenia early.
151
What is the recommendation for Valproate use during pregnancy?
Avoid use during pregnancy
## Footnote
Valproate is a Pregnancy Risk Category D medication.
152
What should clients considering pregnancy while on Valproate do?
Discuss other treatment options with the provider
## Footnote
This is important to avoid potential birth defects.
153
What lifestyle changes should clients be advised to follow due to weight gain associated with Valproate?
Follow a healthy diet and regular exercise regimen
## Footnote
Lifestyle modifications can help manage weight gain.
154
What are the contraindications for Carbamazepine?
Contraindicated in clients who have bone marrow suppression or bleeding disorders
## Footnote
These conditions can be exacerbated by the medication.
155
What should be monitored while undergoing treatment with Valproate and Carbamazepine?
Monitor plasma levels of valproate and carbamazepine
## Footnote
This is critical for ensuring therapeutic effectiveness and safety.
156
What is the therapeutic blood level range for carbamazepine?
4 to 12 mcg/mL.
157
What is the therapeutic blood level range for valproic acid?
50 to 120 mcg/mL.
158
What is important to do when administering lamotrigine?
Lamotrigine needs to be slowly titrated to prevent adverse effects.
159
True or False: Concurrent use of carbamazepine and oral contraceptives increases the effects of oral contraceptives.
False.
160
What effect does carbamazepine have on warfarin?
Decreases the effects of warfarin.
161
What should be monitored when a patient is taking carbamazepine with warfarin?
Therapeutic effects of warfarin.
162
What client education should be provided regarding birth control while on carbamazepine?
Use an alternate form of birth control.
163
What effect does grapefruit juice have on carbamazepine?
Inhibits metabolism, increasing blood levels.
164
What should clients taking carbamazepine avoid?
Intake of grapefruit juice.
165
Which medications decrease the effects of carbamazepine?
Other anticonvulsants.
166
What nursing actions should be taken for carbamazepine?
Monitor carbamazepine levels and adjust dosages as prescribed.
167
Which medications decrease the effect of lamotrigine?
Carbamazepine, phenytoin, phenobarbital.
168
What should be monitored when a patient is taking lamotrigine?
Therapeutic effects.
169
What effect does concurrent use of valproate have on lamotrigine?
Increases the half-life of lamotrigine.
170
What nursing actions should be taken for lamotrigine?
Monitor for adverse effects and adjust dosages as prescribed.
171
True or False: Concurrent use of oral contraceptives increases the effectiveness of both lamotrigine and valproate.
False.
172
What should clients be educated about regarding birth control while on lamotrigine and valproate?
Use an alternate form of birth control.
173
What effect does concurrent use of other anticonvulsants have on valproate?
Affects blood levels of valproate.
174
What nursing actions should be taken for valproate during concurrent use?
Monitor valproate levels and adjust dosages as prescribed.
175
What are some signs of effectiveness in medication for acute manic or depressive manifestations?
Relief of acute manic manifestations or depressive manifestations
## Footnote
Examples include flight of ideas, excessive talking, agitation, fatigue, poor appetite, and psychomotor retardation.
176
What is one way to assess improvement in mood during medication evaluation?
Verbalization of improvement in mood
177
How can the ability to perform ADLs indicate medication effectiveness?
Improved ability to perform Activities of Daily Living (ADLs)
178
Name two lifestyle improvements that can indicate medication effectiveness.
Improved sleeping and eating habits
179
What is a key indicator of social interaction improvement during medication evaluation?
Appropriate interaction with peers
180
List some antipsychotics useful during acute mania.
* Lurasidone
* Olanzapine
* Quetiapine
* Aripiprazole
* Risperidone
* Asenapine
* Cariprazine
* Ziprasidone
181
Which antipsychotics can be used long-term for prophylaxis against mood episodes?
* Ziprasidone
* Olanzapine
* Aripiprazole
182
What medication is specifically approved for bipolar depression?
Lurasidone
