Bipolar Meds

Question 1

What category class is carbamazepine in?

Answer 1

Traditional AEDs

Question 2

What is the expected pharmacological action of carbamazepine?

Answer 2

It inhibits the influx of sodium channels, decrease the discharge of neurons around the areas of increased activity.

Question 3

What is the therapeutic use of carbamazepine?

Answer 3

It treats partial seizures, tonic clonic seizures, acts as a mood stabilizer, and can reduce pain of trigeminal neuralgia.

Question 4

What are the adverse effects of carbamazepine?

Answer 4

-Visual disturbances, headaches, ataxia, nystagmus, and blurred vision.
-Can cause a skin rash, epidermal necrolysis, and Stevens-Johnson syndrome.
-bone marrow suppression can occur.

Question 5

What are the contraindications of carbamazepine?

Answer 5

Treatment of absence and myoclonic seizures and clients who have a hematologic disorder or heart failure. Pregnancy risk teratogenic drug.

Question 6

What precautions should be taken with carbamazepine?

Answer 6

Use with caution: cardiac or hepatic disease, positive results from tests for HLA-B*1502 gene, or history of alcoholism.

Question 7

What are interactions with carbamazepine?

Answer 7

-Grapefruit juice can increase the drugs plasma levels.
-May decrease effectiveness of oral contraceptives and can decrease a false negative on a pregnancy test.
-Antifungals, erythromycin, isoniazid, some antiretrovirals, valproic acid, verapamil, niacin, loratadine, nefazodone, and MAOIs can cause an increase in plasma levels.
-Phenytoin, barbiturates, rifampin, cisplatin, and theophylline can decrease plasma levels of drug.

Question 8

What nursing interventions should be taken for carbamazepine?

Answer 8

-Begin with low dose and increase gradually.
-Split daily dose, giving larger dose at bedtime.
-Monitor pt WBC & CBC throughout therapy.
-If blood values are below expected range, notify provider and stop drug.
-Observe skin for any rash.
-Test Asian clients for HLA-B*1502 gene before therapy.
-Protect pt from sun exposure.

Question 9

What is the medication administration for carbamazepine?

Answer 9

-Admin with meals to reduce gastric upset.
-Don’t chew or crush SR form.
-Don’t mix oral suspension with other oral drug suspensions.
-Keep serum levels of drug consistent.

Question 10

What client education is needed for carbamazepine?

Answer 10

-Watch for CNS effects.
-Don’t drive and take fall precautions.
-Notify provider if rash occurs.
-Report decreased urine output, edema, or SOB.
-Wear sunscreen.

Question 11

What category class is valproic acid/valproate in?

Answer 11

Anticonvulsants

Question 12

What is the expected pharmacological action for valproic acid/valproate?

Answer 12

It inhibits the influx of sodium through sodium channels and decrease the discharge of neurons around areas of increased activity. May affect the influx of calcium and may enhance the inhibitory effects of GABA.

Question 13

What is the therapeutic use for valproic acid/valproate?

Answer 13

It treats all types of seizures, controls mania, and helps prevent migraine headaches.

Question 14

What are the adverse effects of valproic acid/valproate?

Answer 14

-GI upset and indigestion (decreases overtime or with admin of EC form).
-Bruising, bleeding, prolonged bleeding time, and decreased platelets can occur secondary to bone marrow suppression.
-May develop skin rash.
-Liver toxicity and increased risk for hyperammonemia.

Question 15

What are the contraindications of valproic acid/valproate?

Answer 15

-Liver disorder, thrombocytopenia, hyperammonemia, and if taking other anticonvulsants.

Question 16

What precautions should be taken with valproic acid/valproate?

Answer 16

Use with caution: kidney disease, older adults, and children under 2.

Question 17

What interacts with valproic acid/valproate?

Answer 17

-Increased blood levels of phenytoin and phenobarbital when taken concurrently.
-Risk for hyperammonemia increase with topiramate.

Question 18

What nursing interventions should be taken with valproic acid/valproate?

Answer 18

-Monitor for side effects.
-Review lab results for platelets, bleeding time, and ammonia.
-Watch skin for bruising and urine/stool for blood.
-Vomiting, confusion, or decreased LOC may indicate hyperammonemia (report to provider).
-Look for indications of pancreatitis.
-Monitor liver function tests and obtain baseline.
-Observe for symptoms of hepatitis.

Question 19

Medication administration for valproic acid/valproate?

Answer 19

-Orally or by IV.
-If pt develops GI symptoms, take EC tablets.
-Admin with food to minimize gastric distress.
-When giving IV, dilute it in at least 50 mL of diluent and don’t mix with other drugs in the same solution.

Question 20

What client education is needed for valproic acid/valproate?

Answer 20

-Report rash, nausea, vomiting, abdominal pain, jaundice, anorexia, unknown bruises, or unexpected bleeding.
-Contact provider if confusion or decreased LOC occurs.

Question 21

What medication class is lithium carbonate in?

Answer 21

Mood Stabilizer

Question 22

What is the expected pharmacological action of lithium carbonate?

Answer 22

-Not entirely clear.
-Changes the transport of sodium ions in nerve cells, and that alters the metabolism of catecholamines. This helps decrease mania.
-Offers protection against neuronal atrophy and promotes neuronal growth.

Question 23

What is the therapeutic use for lithium carbonate?

Answer 23

-Helps control acute mania and acute manic episodes.
-Used prophylactically to prevent recurrence of mania or depression.

Question 24

What are the adverse effects of lithium carbonate?

Answer 24

-At therapeutic blood levels, clients may experience GI symptoms that often decrease with time.
-Approx 1/3 of clients will experience transient fatigue, headache, confusion, muscle weakness, and memory impairment.
-Polyuria and increased urine output may occur.
-May decrease secretion of thyroid hormone, causing goiter or hypothyroidism.
-Fine hand tremor may develop, exacerbated by stress or fatigue.
-Higher levels can cause: muscle hyperirritability, ECG changes, incoordination, ataxia, blurred vision, seizures, hypotension, and coma.

Question 25

What are the contraindications of lithium carbonate?

Answer 25

Pregnancy, lactating, severe renal insufficiency, moderate/severe cardiac disorders, dehydrated, low serum sodium level, taking diuretics, or who must be on a low-salt diet, and a history of angioedema.

Question 26

What precautions should be taken with lithium carbonate?

Answer 26

Use with caution: history of thyroid or seizure disorders, diabetes, problems with urinary retention, suicidal ideation, and older adults.

Question 27

What interacts with lithium carbonate?

Answer 27

-NSAIDS with exception of aspirin.
-Tetracyclines, diuretics, methyldopa, and probenecid increases risk for lithium toxicity.
-Phenothiazine antipsychotics increase risk for dyskinesia and urinary retention.
-ACE inhibitors may increase lithium levels.

Question 28

What nursing interventions are needed for lithium carbonate?

Answer 28

-Monitor for early transient effects.
-Monitor I&O to watch for symptoms of imbalance.
-Watch for signs of hyperthyroidism.
-Plan to monitor thyroid function tests 1x/year.
-For tremors, monitor for coarsening.
-Monitor serum levels.
-Recognize symptoms that may indicate toxicity.
-Monitor kidney function throughout treatment.

Question 29

Medication administration for lithium carbonate:

Answer 29

-Give with meals or milk to prevent GI effects.
-Swallow SR tablets whole.

Question 30

Client education needed for lithium carbonate?

Answer 30

-If drowsy, don’t drive.
-Plan to avoid caffeine and stressors.
-Notify provider for worsening tremors.
-Report symptoms of hyperthyroidism.
-Recognize signs of toxicity.
-Take with food to decrease GI effects and inform provider if GI effects worsen.