Bipolar Medications

Question 1

Anticonvulsant Mood Stabilizers

Answer 1

valproate/divalproex
carbamazepine
lamotrigine
gabapentin

Question 2

Second-Generation Antipsychotics

Answer 2

• olanzapine
• risperidone
• aripiprazole
• lurasidone
• quetiapine
• ziprasidone

Question 3

Lithium Carbonate

Answer 3

Indications: acute mania and maintenance treatment
Therapeutic and toxic levels
Therapeutic/Maintenance blood level: 0.6 to 1.4 mEq/L
Toxic blood level: 1.5 mEq/L and above
Contraindications: cardiovascular disease, renal disease, brain damage, thyroid disease, pregnant or breast-feeding mothers.

Question 4

Lithium carbonate as a mood stabilizer

Answer 4

Daily dosing: 1200-3000 mg/ day
Most widely used/Effective in 40% of patients with bipolar disorder
Onset: 5 to 7 days, may take as long as 2 weeks
Action: uncertain, crosses cell membranes, alters sodium transport, not protein-bound
Initial labs 1-2 times per week, then…
**Monitor creatinine concentrations, thyroid hormones, & CBC every 6 months
**Kidney damage may be a risk
***Thyroid function may decrease, usually after 6-18 months; observe for dry skin,
hair loss, constipation, bradycardia, and cold intolerance

Question 5

Lithium Carbonate Teaching Points

Answer 5

• Risk of SI when Li+ discontinued-assess for symptoms of depression
• Do not restrict sodium in diet; maintain normal sodium intake
• Hydrate- child may need to take bottled water to school
• If strenuous activity leads to sweating-hydrate more
• If illness causes loss of fluids- contact MD
• Intermittent blood tests are required

Question 6

Valproate/Divalproex (Anticonvulsant Mood Stabilizer)

Answer 6

• Check serum levels
• Broader spectrum of efficacy
• Longer periods of mood stabilization

Question 7

carbamazepine

Answer 7

• Risk of low WBCs: Check serum levels
• Check hepatic and renal function
• Effective in pts who have no response to lithium or with secondary mania
• Rash may be life threatening

Question 8

lamotrigine

Answer 8

• For rapid cycling and depressed phase of bipolar illness
• Rash may be life threatening
• Used as add-on therapy in refractory mood disorders

Question 9

Gabapentin

Answer 9

May be effective for acute mania, mood stabilization, and rapid cycling

Question 10

Lamotrigine Rash

Answer 10

• Stop med immediately
• Can advance to Steven Johnson Syndrome
• occurs within first few months
• Flu-like symptoms
• Sore throat, fever, chills, blisters, burning eyes
• Is an allergic reaction
• Can further advance to toxic epidermal necrosis.

Question 11

Other Treatments

Answer 11

• ECT
• Teamwork and Safety
• Seclusion protocol