Ch 21 Bipolar Meds Flashcards
What does lithium do
Treats bipolar
Controls episodes of acute mania, helps prevent the return of mania or depression,and decreases incidence of suicide.
What are adverse effects of lithium
GI distress Fine hand tremors Polyuria, mild thirst Wt gain Renal toxicity Goiter/hypothyroidism Bradydysrthymias, hypotension, electrolyte imbalances.
What meds are contraindicated with lithium
Diuretics because it can decrease sodium which will increase lithium
NSAIDs can cause toxic accumulation
Anticholinergic meds
When do effects of lithium occur
Within 7-14 days
What meds are used to treat bipolar
Mood stabilizing meds such as lithium carbonate, lithane, lithobid)
Anticonvulsants such as vaproic acid ( depakote, carbamezapine ( tegretol), lamotrigine (Lamical)
Atypical antipsychotics
Anxiolytics such as clonezepam, lorazepam
Antidepressants such as Wellbutrin and sertraline ( Zoloft) they are typically used in combination with a mood stabilizer.
There is evidence that lithium does what
There is evidence that lithium decreases neuronal atrophy and or increases neuronal growth.
What are clinical manifestations of lithium toxicity with levels below 1.5
Diarrhea,n/v, thirst, polyuria, muscle weakness
Fine hand tremors, slurred speech
What are manifestations of lithium toxicity with levels ranging from 1.5-2.0
Mental confusion, poor coordination
Coarse tremors, ongoing GI distress including n/v and diarrhea
What are manifestations of lithium toxicity with levels ranging from 2-2.5
Extreme polyuria of dilute urine
Tinnitus, blurred vision,ataxia, seizures
Severe hypotension leading to coma and possibly death from respiratory complications
What are manifestations of lithium toxicity with levels above 2.5
Rapid progression of manifestations leading to coma and death
What are nursing interventions of lithium toxicity less than 1.5
Instruct client to withhold med and notify provider
Administer new dosage based on serum lithium and sodium levels.
What are nursing interventions for a lithium level of 1.5-2
Withhold med and notify provider
Administer new dosage based on lithium and sodium levels
Excretion may need to be promoted
What are nursing interventions for a lithium level from 2.0-2.5
Administer an emetic to alert clients or administer gastric lavage
Urea, mannitol,or aminophylline may be prescribed to increase the rate of excretion
What are nursing interventions for a lithium level above 2.5
Hemodialysis may be warranted
What are contraindications of lithium
Pregnancy category D
Considered teratogenic especially during the 1st trimester
Discourage breastfeeding if lithium must be used
Use cautiously in renal dysfunction, heart disease, sodium depletion and dehydration
Name mood stabilizing antiepileptic drugs ( anticonvulsants)
Carbamazepine ( Tegretol, Equetro)
Valproic acid ( depakote)
Lamotrigine ( Lamictal)
What are the therapuetic uses of anticonvulsants
Treats manic and depressive episodes, as well as to prevent relapse of mania and depressive episodes. They are particularly useful for ppl who have mixed mania and rapid cycling bipolar disorders
What are adverse effects of carbamazepine ( tegretol, equestro)
Minimal effect on cognitive function
CNS EFFECTS including….nystagmus,double vision, vertigo, staggering gait, headache
Blood dyscrasia’s such as leukopenia, anemia, thrombocytopenia
Teratogenisis
Skin disorders
What are nursing considerations of carbamazepine ( tegretol, Equetro)
Administer in low doses initially and then gradually increase dose
Advise that effects should subside within a few weeks
Administer at bedtime
What are adverse effects of valproic acid
GI effects
Hepatotoxicity
Pancreatitis, thrombocytopenia Teratogenisis
Valproic acid is contraindicated in who
Clients who have bone marrow suppression or bleeding disorders
Clients who have liver disorders
What are med/ food interactions of carbamazepine ( tegretol, equestro)
Oral contraceptives, warfarin
Grapefruit juice increasee levels of carbamazepine
Phenytoin, phenobarbital decreases effects of carbamazepine
What are medication/ food interactions of lamotrigine ( Lamictal)
Carbamezapine, phenytoin, phenobarbital decrease the effects of Lamotrigine
Valproic acid increases the half life of Lamotrigine
Oral contraceptives decrease the effectiveness of both meds
What are med/ food interactions of valproic acid
Phenytoin
Phenobarbital
How can you monitor effectiveness of anticonvulsants
Assess relief of manic symptoms such as flight of ideas, obsessive talking, agitation or depressive symptoms are relieved
