Bipolar Disorders. 9

Question 0

Lithium toxicity

Answer 0

During manic episodes level should be between .8 to 1.4. Maintenance level is between .4 to 1.0.

Early signs is less than 1.5. Diarrhea, nausea and vomiting, thirst, polyurea, muscle weakness, slurred speech. Discontinue medication and notify Dr.

Advanced signs is from 1.5 to 2.0 G.I. distress which is ongoing, mental confusion, poor coordination, course tremors. Discontinue and notify the doctor. Maybe necessary to promote excretion.

Severe toxicity is from 2.0 to 2.5. There is extreme polyurea of dilute urine, tinnitus, blurred vision, ataxia, seizures, severe hypotension leading to coma and death. Give clients an emetic. Perform gastric lavage or administer urea, mannitol, or aminophylline to increase rate of excretion.

Greater than 2.5 will lead to rapid death. Treat with hemodialysis

Question 1

Mood stabilizer

lithium carbonate

Answer 1

Used for bipolar disorders, acute mania, prevents the return of mania or depression, decreases incidence of suicide, alcoholism, bulimia, schizophrenia.
Some side effects resolved within a few weeks. G.I. distress: give medication with milk. Fine hand tremors exacerbated by Kathy: treat with Inderal. Polyurea and mild thirst. Weight gain. Renal toxicity: keep a low dose and test. Hypothyroidism and goiter with long-term treatment. Brady dysrhythmias, hypertension, electrolyte imbalances.

Use with caution in renal dysfunction, heart disease, sodium depletion, and dehydration. Decrease sodium leads to lithium toxicity. Encourage fluids. Use of NSAIDs will lead to toxicity. Avoid anticholinergics.

Effects take 7 to 14 days. Take with food. Keep Lab appointments. Encourage fluids and sodium. Seek attention if diarrhea, vomit, or sweat.

Question 2

Mood stabilizing antiepileptic drugs

Answer 2

Carbamazepine(tegrotol)
Valproic acid (depakote)
Lamotrigine (lamictal)

Treat manic and depressive episodes, prevents relapse of mania and depression. Used for clients with mixed mania and rapid cycling bipolar disorders.

Question 3

Tegrotol

Carbamazepine

Answer 3

CNS effects include nystagmus, double vision, vertigo, staggering gait, headache. Start with a low dose and administer at bedtime.
What dyscrasias such as leukopenia, anemia, thrombocytopenia.
Causes hyperosmolarity and increases risk of fluid overload. Skin disorders such as dermatitis, rash, and Stevens-Johnson syndrome.

It decreases oral contraceptives and warfarin. Do not take with grapefruit juice. Do not use a bone marrow suppression or bleeding disorders

Question 4

Valproic acid

Depakote

Answer 4

GI effects such as nausea and vomiting, indigestion. Hepatotoxic: obtain baseline liver, notify of symptoms. Pancreatitis indicated by nausea and vomiting and abdominal pain. Monitor amylase levels. Thrombocytopenia.

Phenytoin and phenobarbital levels may need to be adjusted. Do not use with liver disorders

Question 5

Lamotrigine

Lamictal

Answer 5

Side effects include double or blurred vision, dizziness, headache, nausea and vomiting. Careful performing activities. Skin rashes such as Stevens-Johnson syndrome. Notify Dr.

Monitor phenytoin and phenobarbital levels