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NURS 527 UNIT 3 > Bi-polar prescribing > Flashcards

Bi-polar prescribing Flashcards

1
Q

What are the therapeutic objectives for treating Bipolar Disorder?

A

Restore balance in moods, stabilize moods for normal daily function, and eliminate acute psychosis if present.

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2
Q

Why is long-term treatment commitment important for Bipolar Disorder?

A

Uncontrolled bipolar disorder can lead to significant burdens, including unemployment, relationship problems, and health issues.

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3
Q

What is the duration of the acute stage of treatment for Bipolar Disorder?

A

The acute stage lasts approximately 2 to 10 weeks.

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4
Q

What is the goal of the acute stage of treatment?

A

Achieve euthymia and resolution of psychosis.

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5
Q

What follow-up monitoring is recommended for individuals with Bipolar Disorder?

A

Monitor for relapse or recurrence, deterioration in function, pregnancy considerations, and substance abuse or health problems.

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6
Q

What is the recommended duration for weaning off medications?

A

Over a 3-month period, and not shorter than 1 month.

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6
Q

How long should the continuation stage of treatment last?

A

Typically lasts from 6 to 12 weeks.

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7
Q

For a first presentation of Bipolar Disorder, how long should therapy ideally continue?

A

A minimum of 6 months, ideally for at least 1 year.

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8
Q

what are thethree main classes of medications used to stabilize mood:

A

Lithium
Anti-convulsants
Atypical Antipsychotics

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9
Q

What is the therapeutic effect of Valproate in bipolar disorder?

A

It is useful for managing hyperactivity between the prefrontal cortex and the limbic system during manic phases and for mood stabilization in maintenance.

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9
Q

What are some advantages of using Lithium?

A

Cost-effective, familiar to clinicians, not metabolized by the liver, excreted unchanged by the kidneys, easily absorbed, does not bind to serum protein, and has a long half-life.

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9
Q

What are the therapeutic levels for Lithium?

A

Trough levels between 0.4 mmol/L and 0.9 mmol/L are therapeutic; levels below 0.4 are likely ineffective, and above 1.0 may indicate toxicity.

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9
Q

What is the typical acute phase dosing for Lithium in mania or depression?

A

600mg TID or 900mg BID of the extended-release formulation.

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9
Q

What is the primary use of Lithium in Bipolar Disorder?

A

Lithium is an effective mood stabilizer and is first-line treatment for acute depressive phases and acute mania.

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10
Q

What are some disadvantages of Lithium?

A

Narrow therapeutic range requiring regular blood level monitoring, potential interactions with diuretics, ACE inhibitors, and NSAIDs, and contraindicated in pregnancy and breastfeeding.

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10
Q

What side effects may occur with Lithium use?

A

Nausea, fine tremors, dry mouth, headache, drowsiness. Toxic symptoms include coarse tremors, nausea, vomiting, confusion, ataxia, and more.

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10
Q

What patient education should be provided for those on Lithium?

A

Importance of fluid intake, wearing a medic alert bracelet, monitoring blood levels, recognizing toxicity symptoms, and informing healthcare providers about Lithium use.

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10
Q

Why should patients inform their surgeon about taking Lithium?

A

Lithium can prolong the effects of neuromuscular blockers used during surgery.

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11
Q

What monitoring is recommended for patients taking Lithium?

A

Weekly Lithium trough levels for 3 weeks, then at 12 weeks check Lithium levels and renal function.

11
Q

What are the advantages of using Valproate?

A

Highly bioavailable, quickly absorbed, half-life of 6 to 16 hours, and peaks in 1 to 4 hours after oral administration.

11
Q

What are the disadvantages of Valproate?

A

It is teratogenic (associated with neural tube defects), should not be taken during pregnancy or breastfeeding, and has significant drug interactions.

12
Q

What is the target serum level for Valproate to control mania?

A

50 to 125 mcg/ml; toxicity occurs at levels above 175 mcg/ml.

12
Q

How does Valproate function in the brain?

A

It blocks GABA uptake into presynaptic neurons, enhances GABA function, slows repolarization, and reduces glutamate activity.

13
Q

What is the typical dosage for Valproate during a manic episode?

A

250mg TID, titratable up to 500mg TID.

13
Q

What mechanisms does Lamotrigine utilize to affect brain activity?

A

It blocks 5-HT3, decreases presynaptic glutamate and aspartate release, and inhibits sodium and calcium channels.

13
Q

What monitoring is required for patients on Valproate?

A

Liver function tests (LFTs) at baseline and monthly for six months, and prior to any surgery.

13
Q

What are the advantages of Lamotrigine?

A

There is usually no fluctuation in weight, and its metabolism does not utilize CYP enzymes.

14
Q

Why should Valproate be tapered gradually when discontinuing?

A

Abrupt discontinuation may precipitate seizures.

14
Q

What should patients taking Valproate avoid?

A

Alcohol, and they should take the medication with food, but not with milk.

14
Q

How can Lamotrigine be used in treating Bipolar Disorder?

A

It can be used as monotherapy for maintenance or as an adjunct to valproate.

15
Q

What is one of the key benefits of Lamotrigine in long-term management?

A

It helps prevent depressive episodes.

15
Q

In which cases is Lamotrigine less effective?

A

It is less helpful in cases with frequent manic episodes but can be beneficial in rapid cycling.

16
Q

What should be done if a rash develops while on Lamotrigine?

A

The drug should be immediately discontinued, and medical care should be sought.

16
Q

What is a significant risk associated with Lamotrigine use?

A

There is a risk of serious rash, including Steven Johnson syndrome, occurring in about 10% of patients in the first two months.

17
Q

What are some common side effects of Lamotrigine?

A

Nausea, diarrhea, dizziness, ataxia, tremor, headaches, menstrual disturbances, and reversible hair loss.

18
Q

What is the usual starting dose of Lamotrigine?

A

50mg, titrated to 100mg BID; if used with valproate, the starting dose is decreased to 25mg.

19
Q

What is the average half-life of Lamotrigine?

A

About 25 hours, but it can double in cases of chronic renal failure.

20
Q

What should be done when discontinuing Lamotrigine?

A

: It should be tapered, and the risks of abrupt cessation should be discussed with the client.

21
Q

Which atypical antipsychotic is known for its high first-pass metabolism, resulting in up to 40% loss before it reaches circulation?

A

Olanzapine undergoes significant first-pass metabolism, which reduces its bioavailability. This is a crucial consideration when prescribing and dosing this medication.

22
Q

What is a common side effect of atypical antipsychotics that may necessitate a medication switch if weight gain exceeds 5%?

A

Atypical antipsychotics, especially olanzapine and quetiapine, are associated with weight gain and metabolic syndrome. If weight gain exceeds 5%, it could indicate increased cardiovascular risk, prompting a reconsideration of treatment.

23
Q

Which of the following is a potential benefit of using atypical antipsychotics in the management of bipolar disorder?

A

Atypical antipsychotics can stabilize mood in bipolar disorder through their effects on serotonin and dopamine receptors, making them effective for both manic and depressive episodes.

24
Q

Which atypical antipsychotic has the shortest half-life?

A

Quetiapine

25
Q

In managing a patient on an atypical antipsychotic, what should be monitored regularly to assess for chronic disease risk factors?

A

Regular monitoring of weight and BMI is essential due to the risk of metabolic syndrome associated with atypical antipsychotic use, which can lead to diabetes and cardiovascular issues.

26
Q

What is the recommended approach for discontinuing an atypical antipsychotic medication?

A

Tapering over at least one month to six weeks

27
Q

Which of the following is an appropriate combination for treating psychosis in bipolar depression?

A

Mood stabilizer plus an antidepressant, followed by weaning the antidepressant

28
Q

which drugs should be avoided in bipolar disorder and why?

A

Tricyclic antidepressants (TCAs) should be avoided in bipolar disorder due to their potential to induce manic episodes. While TCAs can be effective for treating unipolar depression, their use in individuals with bipolar disorder carries a significant risk of destabilizing mood and triggering mania, especially if used without a mood stabilizer.

NURS 527 UNIT 3 (6 decks)

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