CH 23: Meds for Bipolar Disorder Flashcards
Anticonvulsant / Antiepileptic Meds
- valproate/valproic acid (50-120 mcg/mL)
- carbamazepine (4-12 mcg/mL
- lamotrigine
Complications of carbamazepine
- CNS effects
- blood dyscrasias
- teratogenesis
- hypoosmolarity
- skin disorders
CNS effects
Carbamazepine Complication
nystagmus, diplopia, vertigo, headache, staggering gait
- low dose, gradually increase
- admin HS
edu: side effects subside within a few weeks
Blood dyscrasias
Carbamazepine Complication
leukopenia, anemia, thrombocytopenia
- baseline CBC and platelet (ongoing monitoring)
- bruising and bleeding gums=thrombocytopenia
- monitor for infection (fever, lethargy)
Teratogenesis
All Anticonvulsant Med Complication
category D; do not use while pregnant
hypoosmolarity
Carbamazepine Complication
promotes antidiuretic -> inhibits water excretion
- clients w/ heart failure at risk for fluid overload
- monitor blood Na+, edema, decreased output, hypertension
Skin disorders
Carbamazepine & Lamotrigine Complication
rash; Stevens-Johnson syndrome
- withhold med and notify provider
Contraindications of carbamazepine
- bone marrow suppresion
- bleeding disorders
Interactions of carbamazepine and lamotrigine
oral contraceptive decrease
- use alternative contraceptive
Interaction of carbamazepine
grapefruit inhibits metabolism enzyme -> increases carbamazepine
Interaction of carbamazepine and valproate
anticonvulsants affect the effectiveness of the drug
Complications of valproate
- GI upset
- hepatotoxicity
- pancreatitis
- thrombocytopenia
- teratogenesis
- weight gain
GI upset
Valproate Complication
N/V, indigestion
- self-limiting; take w/ food or enteric-coated
Hepatotoxicity
Valproate Complication
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
Pancreatitis
Valproate Complication
evidenced by N/V, abdominal pain
- monitor amylase
- D/C if pancreatisis occurs
Weight gain
Valproate Complication
ensure healthy diet and regular exercise
Complications of lamotrigine
- double/blurred vision, headache, dizziness, N/V
- serious skin rash (Stevens)
Precaution of lamotrigine
slowly titrate to prevent adverse side effects
Interactions of lamotrigine
- carbamazepin, phenytoin decrease its effects
- valproate increase its half-life
Normal ranges of lithium
- maintenance: 0.6-1.2 mEq/L
- during manic episode: 0.8-1.4 mEq/L
Complications of litium
- GI distress
- fine hand tremors
- polyuria, mild thirst
- weight gain
- renal toxicity
- goiter and hypothyroidism
- bradydysrhythmias, hypotension, electrolyte imbalances
GI distress
Lithium Complication
nausea, diarrhea, abdominal pain
- usually transient
- take w/ food or milk
fine hand tremors
Lithium Complication
- 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)
polyuria, mild thirst
Lithium Complication
- use potassium sparing (spiranolactone)
- 1.5-3 L of fluid/day
weight gain
Lithium Complication
healthy diet and regular exercise
Renal toxicity
Lithium Complication
- monitor I&O
- keep dose at lowest
- asses BUN and creatine periodically
Goiter and hypothyroidism
Lithium Complication
- baseline T3, T4, and TSH prior, then continue annually
- admin levothyroxine
- hypothyroidism: cold, dry skin; decrease HR; weight gain
bradydysrhythmias, hypotension, electrolyte imbalance
Lithium Complication
adequate h2o and Na+
Contraindications/Precautions on lithium
- category D
- do not breastfeed while on therapy
- contra for renal/cardiac disease, hypovolemia, schizophrenia
- caution in older adults, thyroid disease, seizure, DM
Interactions of lithium
- diuretics decrease Na+ -> decreases excretion of lithium
- NSAID causes toxicity (aspirin is okay)
- anticholinergics result in abdominal dicomfort
Common adverse effects
< 1.5 mEq/ L
Lithium Toxicity
- diarrhea, N/V
- thirst, polyuria
- muscle weakness, fine hand tremors
- slurred speech, lethargy
- ACTION: often improves over time
Early indications
1.5-2.0 mEq/L
Lithium Toxicity
- 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
Advanced indications
2.0-2.5 mEq/L
Lithium Toxicity
- 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
Sever toxicity
> 2.5 mEq/L
Lithium Toxicity
- rapid progression leading to coma and death
- ACTION: hemodialysis
Administration of lithium
- 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
