Bipolar Drugs

Question 1

Lithium

Answer 1

• Drug of choice
• 80% effective, less effective in rapid cyclers
• Has narrow therapeutic index
• Initial therapeutic level: 0.8 - 1.4 mEq/L
• Maintenance level: 0.4 - 1.0 mEq/L
• Takes approx. 7 to 14 days to reach therapeutic levels
• Blood levels weekly until therapeutic level is reached. After that, levels are checked every month. After 6 months to a year of stability, levels are checked every 3 months
• Blood should be drawn in the a.m., 8 to 12 hours after last dose of Lithium

Question 2

Lithium expected side effects

Answer 2

• Mild thirst
• Mild nausea
• Polyuria
• Weight gain
• Fine hand tremor

Question 3

Lithium signs of toxicity

Answer 3

• N & V
• Diarrhea
• Thirst
• Polyuria
• Lethargy
• Slurred speech
• Muscle weakness
• Fine hand tremor

Question 4

Advance signs of toxicity

Answer 4

• 1.5 - 2.0 mEq/L
• Mental confusion
• Persistent GI upset
• Muscle hyperirritability
• Coarse hand tremor
• Incoordination
• Electroencephalographic (EEG) changes

Question 5

Lithium severe toxicity

Answer 5

• 2.0 - 2.5 mEq/L
• Confusion
• Blurred vision
• Large output of dilute urine
• Ataxia
• Serious EEG changes
• Seizures

Stupor

• Severe hypotension
• Coma, death

Question 6

Lithium major risks

Answer 6

• Hypothyroidism
• Impairment of kidney’s ability to concentrate urine • Therefore, the patient must have periodic follow-ups to assess thyroid and renal function

Question 7

Lithium Health Teaching

Answer 7

· Monitor lithium levels closely
Rationale: has a narrow therapeutic range.

· Maintain normal salt in diet.
Rationale: a low sodium intake leads to a relative increase in lithium retention, which could produce toxicity.

· Report diarrhea, vomiting or diaphoresis.
Rationale: symptoms can lead to dehydration and raise lithium levels in the blood to toxic levels.

· Diuretics are contraindicated.
Rationale: diuretics can cause dehydration and raise lithium levels in the blood to toxic levels.

· Have thyroid and kidneys checked periodically.
** Rationale**: two major long-term risk of lithium therapy are hypothyroidism and impairment of kidney’s ability to concentrate urine.

· Weight gain concerns can be discussed with a nutritionist.
Rationale: weight gain is a side effect of lithium.

· Do not suddenly stop taking lithium.
** Rationale:** can lead to relapse and recurrence of mania.

Question 8

Anticonvulsants

Answer 8

· For patients who do not respond to Lithium or who may not tolerate Lithium or it may be that Lithium is contraindicated or that Lithium may have caused thyroid or kidney damage.

• Tegretol (carbamazepine)
• Depakene/Depakote (valproic acid/valproate)
• Epival (divalproex sodium)
• Lamictal (lamotrigine)
• Neurontin (Gabapentin)
• Topamax (topiramate)

Question 9

Anti Anxiety

Answer 9

· To create calming effects or sedation. Effective in managing psychomotor agitation.
· Offers relatively quick relief from often very disturbing and agonizing symptoms, while the patient waits for the other medications to take effect and control mania or depressive symptoms.

Rivotril (clonazepam)
Ativan (lorazepam)
Valium (diazepam)

Question 10

Antipsychotics

Answer 10

· Supplements to mood stabilizers: to manage acute mania
Zyprexa (olanzapine)

Risperdal (risperidone