bipolar meds (329 E2)

Question 1

medications for acute mania

Answer 1

-mood stabilizers
-atypical antipsychotics
-benzodiazepines

Question 2

mood stabilizing drugs

Answer 2

-lithium (plus an antipsychotic)
-divalproex (plus an antipsychotic)

Question 3

atypical antipsychotics

Answer 3

-risperidone
-quetiapine
-aripiprazole
-olanzapine

Question 4

benzodiazepines

Answer 4

-diazepam
-lorazepam

Question 5

in a bipolar disorder, if we only use an antidepressant for mood stabilization, what are we putting the individual at risk for

Answer 5

a manic episode

Question 6

bipolar disorder meds for mood stabilization

Answer 6

-lithium carbonate
-anticonvulsant mood stabilizers
-second generation antipsychotics
-combination medication

Question 7

anticonvulsant mood stabilizers

Answer 7

-valproate/sodium valproate/divalproex sodium
-carbamazepine
-lamotrigine
-gabapentin (great for acute mania & rapid cycling)

Question 8

combination medication

Answer 8

symbax (olanzapine & fluoxetine)
if patient has bipolar and are typically more depressed -> bipolar 2 disorder

Question 9

lithium carbonate: indications

Answer 9

acute mania and maintenance treatment of bipolar disorder

Question 10

lithium carbonate: nursing considerations

Answer 10

need to monitor therapeutic levels
-therapeutic is 0.6-1.4
-toxic is 1.5 and above
-initial labs 1-2x per week then monitor creatinine concentrations, thyroid hormones & CBC every 7 months
-risk of kidney damage
-thyroid function may decrease so observe for dry skin, hair loss, constipation, bradycardia and cold intolerance

Question 11

lithium carbonate: contraindications

Answer 11

CVD
renal disease
brain damage
thyroid disease
pregnant
breast feeding

Question 12

lithium carbonate: expected SE

Answer 12

-N/V/D
-thirst & polyuria
-lethargy & sedation
-fine hand tremor
if these are seen, titrate down

Question 13

lithium carbonate: early signs of toxicity

Answer 13

-GI upset
-course hand tremor
-confusion
-hyperirritability of muscles
-electroencephalographic changes
-sedation
-incoordination

Question 14

lithium carbonate: advanced signs of toxicity

Answer 14

-ataxia
-giddiness
-serious electroencephalographic changes
-sedation
-incoordination

Question 15

lithium carbonate: severe toxicity

Answer 15

-convulsions
-oliguria
-death

Question 16

Lithium Carbonate overview

Answer 16

-most widely used mood stabilizer
-dosing: 1200-300 mg/d
-onset 5 to 7 days
-crosses cell membranes, alters Na transportm not protein bound

Question 17

lithium teaching points

Answer 17

-study showed increased risk of SI when Li+ discontinued, assess for sx of depression
-do not restrict sodium in diet, maintain normal Na intake
-hydrate: child may need to take bottle 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 18

valproate

Answer 18

-anticonvulsant
-check serum levels
-longer periods of mood stabilization

Question 19

cabamazepine

Answer 19

-anticonvulsant
-check serum levels
-risk of low WBCs
-check hepatic and renal function
-effective in pts who have no response to lithium or w/ secondary mania
-rash may be life threatening

Question 20

lamotrigine

Answer 20

-anticonvulsant
-for rapid cycling and depressed phase of bipolar illness
rash may be life threatening
-used as add on therapy in refractory mood disorders
try lithium first

Question 21

gabapentin

Answer 21

-anticonvulsant
-may be effective for acute mania, mood stabilization and rapid cycling
try lithium and lamotrigine first

Question 22

lamotrigine rash

Answer 22

stop med immediately
-can advance to Steven Johnson Syndrome
-flu like sx
-is an allergic reaction
-can further advance to toxic epidermal necrosis

Question 23

other non pharm for bipolar

Answer 23

-ECT
-teamwork & safety
-seclusion protocol
-support groups
-health teaching & promotion