Ch 9- bipolar disorders Flashcards
Lithium carbonate purpose
Mood stabilizer
Lithium carbonate adverse effects
GI distress Fine hand tremors Polyuria, mild thirst Weight gain Renal toxicity Goiter and hypothyroidism (w/long term) Bradydysrythmia Electrolyte imbalance
Lithium less than 1.5
Diarrhea Nausea Vomiting Thirst Polyuria Muscle weakness Fine hand tremor Slurred speech
Lithium 1.5-2
Nausea Vomiting Diarrhea Mental confusion Poor coordination Coarse tremors
Lithium 2-2.5
Extreme polyuria Blurred vision Ataxia Seizures Severe hypotension Coma Death
Intervention: give alert patients emetic
Perform gastric lavage or admin mannitol or aminophylline to increase excretion
Lithium greater than 2.5
Rapid progression of symptoms
Coma
Death
Intervention: Hemodialysis
Lithium interactions
Reduces serum sodium decrease lithium excretion = toxicity
NSAIDs lead to toxicity
Anticholinergics (antihistamines , tricyclic antidepressants) induce urinary retention and polyuria
Nursing admin lithium
Monitor levels 2-3 days then every 2-3 mo
Obtain in morning
12 hrs after last dose
Initial treatment lithium level
.8-1.4
Maintain lithium level
.4-1
Plasma toxicity
> 1.5
Antiepileptic drugs (AEDs)
Carbamazepine (Tegretol, Equetro)
Valproic acid (Depakote)
Lamotrigine (Lamictal)
Carbamazepine adverse effects
CNS effects
Blood dyscrasias (leukopenia, anemia, thrombocytopenia)
Teratogenesis (avoid during preg)
Hypo osmolarity -fluid overload
Skin disorders (dermatitis, rash, Stevens Johnson’s)
Lamotrigine
Blurred vision Dizziness Headache Nausea Vomiting
Stevens Johnson’s
Valproic acid adverse effects
GI Hepatotoxicity Pancreatitis Thrombocytopenia Teratogenesis
Carbamazepine interactions
Decrease effects of BC and warfarin
Grapefruit juice inhibits metabolism increasing levels
Phenytoin and phenobarbital decrease effects
Lamotrigine interactions
Carbamazepine
Phenytoin
Phenobarbital
> decrease effects
Valproic acids increase half life
Valproic acid interactions
Concurrent use increases levels of phenytoin and phenobarbital
Lithium carbonate teaching
Increase fluids
Increase sodium
Take with food or milk
*thyroid function assessed periodically
Avoid aerobic activity in hot water (sodium water depletion)
Avoid NSAIDs (take acetaminophen)
Avoid during pregnancy
Valproic acid tests
Thrombocyte count
Amylase
Liver function
