Bipolar Disorders

Question 1

What is the therapeutic outcome of mood stabilizers?

Answer 1

neurochemical changes that can stabilize mood in acute mania, prevent return of mania or depression, and decrease incidence of suicide

Question 2

What is lithium carbonate commonly referred as?

Answer 2

lithium salts because the body treats lithium like a salt

Question 3

What are some other medications that are considered mood stabilizers?

Answer 3

antiepileptics (valproic acid and carbamazepine)

atypical antipsychotics

anxiolytics

antidepressants

Question 4

What are some adverse effects of lithium?

Answer 4

FINE TREMORS (indicative of high levels, not necessarily toxic, but could be early sign)

GI: n/v diarrhea, abdominal pain (indicative of high levels, not necessarily toxic, but could be early sign)

weight gain - compliance issue

bradydysrrhythmias and hypotension

hypothyroidism - long term use (fatigue, sesitivity to cold, dry skin, constipation, thin hair, bradycardia)

many drug-drug interactions - obtain thorough medication history

Question 5

What are some nursing considerations for lithium carbonate?

Answer 5

beta-blockers may help with fine tremors, may need to lower dose if fine tremors are present, serum levels should be investigated (high levels)

GI effects could mean levels are high, check serum drug levels

weight gain is a compliance issue

monitor ECG, BP, HR

report signs of hypothyroidism, monitor T3, T4, and TSH labs

obtain a thorough medication history because of the many drug-drug interactions

monitor serum drug levels!!

Question 6

What is the normal therapeutic range for lithium?

Answer 6

0.4-1

for first initial stabilization treatment some references state levels of 1.2-1.4

Question 7

At a level of 1.2-1.5 serum lithium levels, what manifestations of toxicity might occur?

Answer 7

diarrhea, n/v, thirst, polyuria, fine hand tremors, slurred speech, weakness

(increased “salt” levels will cause kidneys to secrete more sodium and water and cause thirst)

Question 8

At a level of 1.5-2 serum lithium levels, what manifestation of toxicity might occur?

Answer 8

Same as lower tier (n/v, thirst, polyuria, slurred speech, weakness) but there will now be coarse tremors and mental confusion

Question 9

What are some manifestations of lithium toxicity at serum drug levels of 2.0-2.5?

Answer 9

extreme polyuria, blurred vision, tinnitus, ataxia, slurred speech, seizures, severe hypotension, respiratory depression

Question 10

At serum lithium levels > 2.5 what manifestations of toxicity might occur?

Answer 10

extreme symptoms leading to coma or death.

Question 11

What is one main thing that can cause lithium toxicity?

Answer 11

hyponatremia!

hypernatremia can cause to body to excrete more lithium, decreasing the therapeutic effects

Question 12

What should be monitored to prevent lithium toxicity?

Answer 12

monitor sodium and fluid intake!

encourage 2-3L water daily (helps regulate lithium levels, dehydrated patient will retain “salts” such as lithium, increasing the levels

Maintain proper sodium levels, dont change diet!!

Question 13

What pregnancy category is lithium carbonate?

Answer 13

category D

Question 14

What are some patient teaching points for lithium carbonate?

Answer 14

do not limit/increase the use of salt without talking to a healthcare provider

maintain adequate fluid intake (2-3L daily) to maintain proper hydration and normal lithium levels - watch heavy sweating with exercise (low sodium levels will increase lithium levels)!!

prevent pregnancy (category D)

report signs of lithium toxicity - hold medication and call provider if experiencing diarrhea, vomiting, hand tremors, excessive sweating

keep lab appointments - initially every 2-3 days (initial dosing regulation), then 1-3 months (once levels maintained)

therapeutic effects occur in 1-2 weeks - continue taking because effects may take a while to occur