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N222 - Mental Health/Psychiatric > CH 23: Meds for Bipolar Disorder > Flashcards

CH 23: Meds for Bipolar Disorder Flashcards

1
Q

Anticonvulsant / Antiepileptic Meds

A
  • valproate/valproic acid (50-120 mcg/mL)
  • carbamazepine (4-12 mcg/mL
  • lamotrigine
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2
Q

Complications of carbamazepine

A
  • CNS effects
  • blood dyscrasias
  • teratogenesis
  • hypoosmolarity
  • skin disorders
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3
Q

CNS effects

Carbamazepine Complication

A

nystagmus, diplopia, vertigo, headache, staggering gait
- low dose, gradually increase
- admin HS
edu: side effects subside within a few weeks

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4
Q

Blood dyscrasias

Carbamazepine Complication

A

leukopenia, anemia, thrombocytopenia
- baseline CBC and platelet (ongoing monitoring)
- bruising and bleeding gums=thrombocytopenia
- monitor for infection (fever, lethargy)

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5
Q

Teratogenesis

All Anticonvulsant Med Complication

A

category D; do not use while pregnant

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6
Q

hypoosmolarity

Carbamazepine Complication

A

promotes antidiuretic -> inhibits water excretion
- clients w/ heart failure at risk for fluid overload
- monitor blood Na+, edema, decreased output, hypertension

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7
Q

Skin disorders

Carbamazepine & Lamotrigine Complication

A

rash; Stevens-Johnson syndrome
- withhold med and notify provider

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8
Q

Contraindications of carbamazepine

A
  • bone marrow suppresion
  • bleeding disorders
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9
Q

Interactions of carbamazepine and lamotrigine

A

oral contraceptive decrease
- use alternative contraceptive

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10
Q

Interaction of carbamazepine

A

grapefruit inhibits metabolism enzyme -> increases carbamazepine

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11
Q

Interaction of carbamazepine and valproate

A

anticonvulsants affect the effectiveness of the drug

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12
Q

Complications of valproate

A
  • GI upset
  • hepatotoxicity
  • pancreatitis
  • thrombocytopenia
  • teratogenesis
  • weight gain
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13
Q

GI upset

Valproate Complication

A

N/V, indigestion
- self-limiting; take w/ food or enteric-coated

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14
Q

Hepatotoxicity

Valproate Complication

A

evidenced by anorexia, N/V, abdominal pain, fatigue, jaundice
- baseline liver function regularly (every 2 months for the first 6 months
- do not admin to 2 years or younger
- admin lowest effective dose

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15
Q

Pancreatitis

Valproate Complication

A

evidenced by N/V, abdominal pain
- monitor amylase
- D/C if pancreatisis occurs

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16
Q

Weight gain

Valproate Complication

A

ensure healthy diet and regular exercise

17
Q

Complications of lamotrigine

A
  • double/blurred vision, headache, dizziness, N/V
  • serious skin rash (Stevens)
18
Q

Precaution of lamotrigine

A

slowly titrate to prevent adverse side effects

19
Q

Interactions of lamotrigine

A
  • carbamazepin, phenytoin decrease its effects
  • valproate increase its half-life
20
Q

Normal ranges of lithium

A
  • maintenance: 0.6-1.2 mEq/L
  • during manic episode: 0.8-1.4 mEq/L
21
Q

Complications of litium

A
  • GI distress
  • fine hand tremors
  • polyuria, mild thirst
  • weight gain
  • renal toxicity
  • goiter and hypothyroidism
  • bradydysrhythmias, hypotension, electrolyte imbalances
22
Q

GI distress

Lithium Complication

A

nausea, diarrhea, abdominal pain
- usually transient
- take w/ food or milk

23
Q

fine hand tremors

Lithium Complication

A
  • exacerbated by stress and caffeine
  • admin beta blocker (propranolol)
  • adjust dosage to as low as possible; give in divided doses; use long-acting formulations
  • report an increase in tremors (lithium toxicity)
24
Q

polyuria, mild thirst

Lithium Complication

A
  • use potassium sparing (spiranolactone)
  • 1.5-3 L of fluid/day
25
Q

weight gain

Lithium Complication

A

healthy diet and regular exercise

26
Q

Renal toxicity

Lithium Complication

A
  • monitor I&O
  • keep dose at lowest
  • asses BUN and creatine periodically
27
Q

Goiter and hypothyroidism

Lithium Complication

A
  • baseline T3, T4, and TSH prior, then continue annually
  • admin levothyroxine
  • hypothyroidism: cold, dry skin; decrease HR; weight gain
28
Q

bradydysrhythmias, hypotension, electrolyte imbalance

Lithium Complication

A

adequate h2o and Na+

29
Q

Contraindications/Precautions on lithium

A
  • category D
  • do not breastfeed while on therapy
  • contra for renal/cardiac disease, hypovolemia, schizophrenia
  • caution in older adults, thyroid disease, seizure, DM
30
Q

Interactions of lithium

A
  • diuretics decrease Na+ -> decreases excretion of lithium
  • NSAID causes toxicity (aspirin is okay)
  • anticholinergics result in abdominal dicomfort
31
Q

Common adverse effects

< 1.5 mEq/ L

Lithium Toxicity

A
  • diarrhea, N/V
  • thirst, polyuria
  • muscle weakness, fine hand tremors
  • slurred speech, lethargy
  • ACTION: often improves over time
32
Q

Early indications

1.5-2.0 mEq/L

Lithium Toxicity

A
  • mental confusion, sedation
  • poor coordination, coarse tremors
  • GI distress (N/V/D)
  • ACTION: withhold and notify; admin new dose based on blood lithium & Na+ levels; excretion can be promoted
33
Q

Advanced indications

2.0-2.5 mEq/L

Lithium Toxicity

A
  • extreme polyuria of dilute urine
  • tinnitus, blurred vison
  • giddiness, ataxion, jerking movements, seizure
  • severe hypotension & stupor leading to coma and possibly death due to respiratory depression
  • ACTION: admin emetics to alert client or gastric lavage; urea, mannitol, or aminophylline admin to increase excretion
34
Q

Sever toxicity

> 2.5 mEq/L

Lithium Toxicity

A
  • rapid progression leading to coma and death
  • ACTION: hemodialysis
35
Q

Administration of lithium

A
  • initiation of tx, monitor levels every 2-3 days until stable and then every 1-3 months (higher levels can be required 1-1.5 mEq/L)
  • levels should be obtained in the morning, 10-12 hours after last does
  • effects begin within 5-7 days; max effects seen in 2-3 weeks
  • admin 2-3 doses/day due to short half-life

N222 - Mental Health/Psychiatric (7 decks)

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