bipolar d/o W4 Flashcards
BPD medications
anticonvulsant mood stabilizers
- sodium valproate/divalproex sodium/valproic acid
- carbamazepine
- lamotrigine
- gabapentin
other
- lithium carbonate
combination med
- symbax (olanzapine: antipsychotic + fluoxetine: SSRI)
antipsychotics
- olanzapine
- risperidone
- aripiprazole
- quetiapine
benzodiazepines
- diazepam
- lorazepam
Types
Bipolar ___ disorder
- Most severe form
- Highest mortality rate
- Involves atleast 1 manic episode
Bipolar ___ disorder
- Atleast 1 hypomanic episode
- At least 1 major depressive episode
1
2
BPD With rapid cycling
- 4 or more manic episodes for at least 2 weeks in 12 months
- Partial/full remission for 2 months at a time or switch to opposite episode
- High risk of recurrence
- Resistant to drug therapy
- Greater severity of illness
- Depressive symptoms predominate
BPD With Mixed features – symptoms of both depression and mania occur at the same time
Mania
D – distractibility
I – indiscretion, impulsive, impaired judgement
G – grandiosity delusions
F – flight of ideas
A – activity increase
S – sleep deficit
T – talkativeness
s/s mania
- Mood liability – extreme, rapid mood swings, irritability or sudden outburst of misplaced rage
- Quick to anger
- Feels misunderstood
- Low frustration tolerance
- Pacing
- Dramatic mannerisms
- Uses jokes, puns
- Flamboyant or sexual dress
__________
- Episode r/t definite noticeable by others change in functioning uncharacteristic for the individual
- Episode is not severe enough to cause a marked impairment in social or occupational functioning or hospitalization
- No psychotic features
- Mood is elevated, expansive, or irritable for at least 4 days
Hypomania
Psychotic features = mania or hypomania?
mania
Mania vs hypomania
- both characterized by elevated mood and increased energy levels
- differ in severity and duration
_________
- more severe, with symptoms lasting at least one week and causing significant impairment in daily functioning
- involves psychotic features like delusions or hallucinations.
- associated with Bipolar I Disorder
- requires immediate intervention due to its acute nature and potential for harmful consequences.
___________
- less extreme and does not lead to marked impairment, though others may notice changes in behavior.
- episodes are shorter, lasting at least four days.
- seen in Bipolar II Disorder
Mania
Hypomania
Nursing care: acute mania
- Initial plan of care focuses on exhaustion and nutrition
- Managing medications
- Decreasing physical activity – walking with nurse ok
- Increasing food/fluid intake
- Ensure minimum 4-6 hours of sleep per night
- Intervene for self-care needs and setting limits on behavior
- Injury prevention
- Establish quiet environment
- Best diet considerations – finger foods high in protein (bananas and peanut butter sandwich)
Patient/family Teaching
- Chronic and episodic nature of bipolar disorder
- Treatment requires 1+ mood stabilizing agents taken for long time
- s/e and toxic s/e
- relapse s/s
- alcohol, drugs, caffeine, and OTC meds can cause relapse
- good sleep hygiene is critical for stability – lack of sleep can be r/t manic episode, sleep meds can avert a manic episode
- coping strategies
- therapy
meds for mania
mood stabilizers regimen:
- lithium (other) + antipsychotic
- sodium valproate/divalproex sodium/valproic acid (anticonvulsant mood stabilizers) + antipsychotic
antipsychotics
- olanzapine
- risperidone
- aripiprazole (older than 10 y/o)
- quetiapine
- ziprasidone
benzodiazepines – severe agitation, short term use
- diazepam
- lorazepam
- clonazepam
meds for mood stabilization: bipolar disorder
anticonvulsant mood stabilizers
- sodium valproate/divalproex sodium/valproic acid
- carbamazepine
- topiramate
- lamotrigine
- gabapentin
other
- lithium carbonate
combination med
- symbax (olanzapine: antipsychotic + fluoxetine: SSRI)
antipsychotics
- olanzapine
- risperidone
- aripiprazole
- quetiapine
- lurasidone
- ziprasidone
lithium carbonate
indications – acute mania, maintenance treatment, bipolar disorder
contraindications
- CV disease
- Renal disease
- Brain damage
- Thyroid disease
- Pregnant or breastfeeding mothers
Labs –
- Initially 1-2 times per week
- Monitor creatinine, thyroid, CBC q 6 months
Teaching
- Risk of SI when lithium is d/c – assess for s/s of depression
- Do not restrict sodium
- Hydration
- If sweating hydrate more
- If illness causes loss of fluids – contact MD
- Intermittent blood tests required
lithium s/e vs toxicity
expected side effects:
- n/v, diarrhea
- thirst
- polyuria
- lethargy, sedation
- fine hand tremor
- risk for renal toxicity/damage – long term use
- risk for thyroid disfunction - goiter and hypothyroidism – monitor for dry skin, hair loss, constipation, bradycardia, cold intolerance
early signs of toxicity:
- GI upset
- Coarse hand tremor
- Confusion, sedation, incoordination
- Hyperirritability of muscles
- Electroencephalographic changes
Advanced signs of toxicity:
- Ataxia
- Giddiness
- Serious Electroencephalographic changes
- Blurred vision
- Clonic movements
- Large output of diluted urine
- Seizures
- Stupor
- Severe HTN
- Coma
- Death 2ndary to pulmonary complications
Severe toxicity:
- Convulsions
- Oliguria
- Death
sodium valproate/divalproex sodium/valproic acid
anticonvulsant mood stabilizer
- Example of Anticonvulsant med that might be prescribed for bipolar disorder
- Check serum levels
- Broad spectrum of efficacy
- Longer periods of mood stabilization
carbamazepine
anticonvulsant mood stabilizer
- Risk of low WBC – check serum levels
- Check hepatic and renal function
- Effective in pts who have no response to lithium or with 2ndary mania
- Rash may be life threatening
Lamotrigine
anticonvulsant mood stabilizer
- For rapid cycling and depressed phase of bipolar illness
- Rash may be life threatening
o Is an allergic reaction
o Stop meds immediately
o Can advance to toxic epidermal necrosis
o Can advance to steven johnson syndrome (w/in first few weeks)
o Flu like symptoms – sore throat, fever, chills, blisters, burning eyes
- Used as add on therapy in refractory mood disorders
gabapentin
anticonvulsant mood stabilizer
- Indicated for acute mania, mood stabilization, rapid cycling
Other treatment: ECT
Electroconvulsive therapy
- Used to subdue severe manic behavior
- Useful with treatment resistant mania and rapid cycling
- More effective than drugs for treatment resistant bipolar depression
- Depressive episodes – severe, catatonic, treatment resistant depression
