Bipolar 1 & 2 Flashcards
1
Q
What are 4 classifications of drugs used to treat mania?
A
Antipsychotics
Anticonvulsants
Anti-anxiety
Lithium
2
Q
What does Lithium do to treat mania?
A
It is a mood stabilizer and it may take weeks to work.
3
Q
What do antipsychotics do for mania?
A
Brings mania down quickly, in several days.
4
Q
What do anticonvulsants do for mania?
A
Act as mood stabilizers.
5
Q
When are anti-anxiety meds used for mania?
A
They are used if other medications can not be used.
6
Q
What is Lithium Carbonate, and what is it used for?
A
A natural salt, that is used for the treatment of bipolar disorder?
7
Q
What is the therapeutic blood level of lithium carbonate?
A
0.8 to 1.4 mEq/L
8
Q
What is the toxic blood level for Lithium carbonate?
A
1.5 mEq/L and above
9
Q
What is the maintains blood level of Lithium carbonate for the treatment of mania and depression?
A
0.4 to 1.3 mEq/L
10
Q
What is the therapeutic mg dosage of Lithium?
A
300-2700 mg/day
11
Q
What are the adverse side effects of Lithium?
A
Lithium toxicity and death
12
Q
What are the contraindications for Lithium?
A
Pregnancy & breastfeeding
13
Q
What is important to know about children and Lithium?
A
It is toxic and should not be given to the,
14
Q
What does Lithium do for thirst and dehydration ?
A
Increases thirst and dehydration?
15
Q
When taking lithium what does dehydration lead to?
A
Lithium retention and toxicity
16
Q
What does caffeine do to lithium levels?
A
Decreases lithium levels in the blood
17
Q
What six things should patients avoid when taking Lithium?
A
Alcohol, caffeine, diuretics, SSRI, NSAIDS, ace inhibitors
18
Q
What medications increase Lithium levels?
A
Diuretics, SSRI, NSAIDS, ACE inhibitors
19
Q
What decreases Lithium levels?
A
Caffeine
20
Q
If Lithium causes nausea, what should you advise the patient to do?
A
Take with food
21
Q
What medication is often used with Lithium?
A
Antipsychotics
22
Q
How many days can Lithium take to reach its therapeutic level?
A
7 - 21 days
23
Q
What are initial/transient symptoms of Lithium?
A
Dry mouth, metallic taste, nausea, mild sleepiness, dizziness, mental dulling
24
Q
What are the symptoms of Lithium?
A
Polydipsis, polyuria, weight gain, mild hand tremor.
25
How much weight gain is normal for being on Lithium?
5 - 10 lbs up to 50
26
What are patient teachings for lithium toxicity?
Blurred vision, diarrhea, muscle weakness, drowsiness, feeling shaky, lack of coordination,
27
What symptoms can lithium toxicity lead to?
Seizures, coma, death, cardiovascular collapse
28
How often does a patient need to check their lithium blood levels when initially starting treatment?
Weekly
29
How soon can blood be drawn after the last dose of lithium?
8-12 hrs
30
How does lithium effect your thyroid?
Can cause HYPO thyroidism. Need to order a ths test.
31
What doe lithium do to kidney function?
It can impair renal function. Order creatinine test or BUN
32
What are atypical antipsychotics that are used to treat mania?
O Lana'Paine (zy'prexa)
| Ris per' Idone (ris'perdal)
33
Whit is used to reduce mania before lithium is at the therapeutic level?
Antipsychotics
34
Once lithium begins to work, what is often discontinued?
Antipsychotics
35
Why are antipsychotics used to treat mania?
Because they are better tolerated than lithium, they reduce mania quicker, and prevent relapse
36
What can anticonvulsant drugs cause when using to treat mania?
Suicidal thinking
37
What are three anticonvulsant drugs used for treatment of mania?
Valproate (depakote)
Carbamazepine (tegretol)
Lamotrigin (lamictal)
38
What is important to each for when treating with lamotrigine?
Life threatening TENS rash?
39
What is toxic epidermal nec'rolysis?
Lamicital TENS rash
40
How is TENS rash treated?
IV immunoglobulin for 5 days
41
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A patient who has been taking lithium carbonate 300mg tid comes to the office with a list of meds he is taking. Which med would require re-evaluation of lithium dosage and why?
A. Respirdal
B. Ativan
C. Amoxicillin
D. HydroDiuril
```
D. HydroDiuril because it is a diuretic
42
What antianxiety meds are used for bipolar?
Colnazepam (klonopin)
| Lorazepam (Ativan)
43
When are antianxiety meds used for acute mania?
Used if patient is resistant to other treatments
44
What do antianxiety meds do for patients with acute mania?
Manages psychomotor agitation and aids in sleep
45
Which anticonvulsant medication medication might be prescribed for a patient with bipolar disorder?
A. Divalproex sodium or valproate (depakote)
B. Clonazepam (klonopin)
C. Olanzapine (Zyprexa)
D. Lithium (lithobid)
A. Divalproex sodium or valproate (depakote)
46
What % does genetics play in bipolar inheritance?
80% - 90%
47
The occurrence rate of bipolar is how much higher if a parent or sibling has BMD?
5-10 times higher
48
What disorder is a cyclic illness?
Bipolar disorder
49
What does polygenic mean?
That multiple genes are involved.
50
True or false BMD is a polygenic disorder?
True
51
What happens to dopamine and serotonin levels in people with BMD?
Decrease
52
What causes insomnia in BMD patients?
Polygenic disease = multiple genes involved including abnormal circadian levels leading to super fast biological clock leading to insomnia for days.
53
What is the elevated form of BMD?
Mania
54
What are the two different episodes of behavior in a BMD patient?
Elevated (mania) and depressive
55
What is the suicide attempt rate in BMD patients?
25- 60%
56
What is the % of death from suicide in the bipolar population?
10-20%
57
When is the suicide risk greater in the BMD patient?
When they are emerging from a depression or during mixed episodes.
58
What substances can cause or appear to be mania?
Amphetamine
Cannabis
Steroids
Antidepressants (especially Ssri may flip person into mania)
59
What other medical conditions can appear to be mania?
Schizophrenia
Schizoaffective depression
Hyperthyroid
60
Hypothyroidism can mimic what for of BMD?
Depression
61
Hyperthyroidism can mimic what form of BMD?
Mania
62
Define bipolar 1.
Classic bipolar, mania.
63
Define bipolar 2.
Severe depression and hypomanic episodes.
64
Is depression or hypomania required for a diagnosis of bipolar 1?
No
65
Is mania required for a diagnosis of bipolar 2?
No
66
Define cyclothymic.
Mild hypo mania and mild depression, not MDD
67
What is the assessment tool DIG FAST used for?
To assess for a bipolar manic Episode
68
Define D in DIG FAST
Distractibility
69
Define I in DIG FAST
Indiscretion, Impatience, and Irritability
70
Define G in DIG FAST
Grandiosity
71
Define F in DIG FAST
Flight of ideas and energy
72
Define A in DIG FAST
Activity increase
73
Define S in DIG FAST
Sleep deficit
74
Define T in DIG FAST
Talkative - excessively
75
To be diagnosed with Bipolar 2 the patient has to have a major depressive episode and a hypomanic episode. Name the 7 things that count as hypomanic symptoms.
- Weight loss or gain of more than 5% body weight in one month
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- feelings of worthlessness or inappropriate guilt
- diminished ability to think concentrate or make decisions
- recurrent thoughts or suicide or death
76
Define Rapid cycling in BMD.
4 or more mood cycles in a 12 month period, they can occur in a day, month or year
77
When is rapid cycling often diagnosed
Earlier, teens
78
Is rapid cycling a less or more sever illness than Bipolar 1 and 2?
More serious illness and often has more sever symptoms
79
What drugs are used to treat Rapid cycling?
Valproate (depakote)
Carbamazepine (tegratol)
lamotrigene (limictal) (watch for TENS rash)
80
Define mixed features as related to bipolar 1 and 2.
Both manic and depressive symptoms at the same time but not cyclic.
81
How to you treat Mixed features?
Anticonvulsants or antipsychotics
82
When is ECT used for Bipolar disorder?
For patients who's medication does not work or for patients that have severe depressive episodes or highly suicidal or catatonic episodes.
83
Define Anosognosia
without knowledge of the disease, patients experiencing mania do not always have the insight to recognize that they suffer from a mental illness, it is not denial!
84
How do you treat the Acute phase of Bipolar disorders?
Hospitalize and provent injury
85
How do you treat the continuation phase of Bipolar disorders?
Community, psychoeducational groups in community for patient and family to focus on relapse prevention.
86
How do you treat the maintenance phase of Bipolar disorder?
Ongoing support, limit severity and duration of future episodes
87
What are the three areas to monitor for in the nursing assessment of patients with bipolar disorder?
Safety of the patient and others, suicidal risk (coming out of depress or mixed episodes increase risk), medication adherence and response to ordered medication.
88
What history is important to obtain in the nursing assessment of the Bipolar patient?
Medication history and adherent to medications, Past and present sleep patterns and nutritional intake, alcohol and drug abuse history, underlying medical conditions.
89
What four assessment areas are important in the Bipolar patient?
Mood, Behavior, Cognitive functioning, Thought processes and speech patterns.
90
What are five characteristics of thought processes and speech patterns in the bipolar patient with mania?
Pressured speech, flight ideas, circumstantial, clang associations, grandiosity.
91
Define Pressured speech of the manic patient
hasty, emphatic, speech, often too loud
92
Define flight of ideas of the manic patient
constant flow of fast speech abrupt changes of topic
93
Define Circumstantial thought processes and speech patterns in the manic patient.
Includes much indirectness with lots of details and may never get to the point
94
Define clang associations in the manic patient.
Meaningless rhyming of words often with force
95
Define grandiosity in the manic patient.
inflated self-regard of ideas "I can do anything"
96
What are four things to remember with communicating with the client in an acute manic phase.
Firm and calm approach, use short concise statements, state that behavior that is expected of the patient, remain neutral and avoid power struggles.
97
What is important in discharge planning of the Bipolar patient?
Assess patient to identify triggers for becoming depressed or manic, and to identify the warning signs of a serious mood change.
98
What is the purpose of interpersonal and social rhythm therapy?
To reduce relapse of bipolar disorder.
99
What does interpersonal and social rhythm therapy involve?
Regular schedule of daily activities (sleeping), healthy relationships.
