Medications For Bipolar Disorder

Question 1

Therapeutic use of Lithium

Answer 1

Helps control acute mania and the acute manic episodes associated with bipolar disorder
- It is used prophylactically to prevent recurrence of mania or depression

Question 2

MOA: Lithium

Answer 2

Alters metatobilism of catecholamines, the flight-or-fight hormones the adrenal glands release in response to stress.
- offers protection against neuronal atrophy, promotes neuronal growth

Question 3

Safety ranges for Lithium levels

Answer 3

Acute mania: 1 - 1.5 mEq/L
Maintenance: 0.6 - 1.2

Question 4

At what level is Li considered toxic?

Answer 4

Above 1.5 mEq/L

Question 5

Lithium toxicity

Answer 5

Mental confusion, sedation, poor coordination, coarse tremors, ongoing GI distress; nausea and vomiting and diarrhea (early signs), muscle weakness (early signs)

Extreme toxicity S&S
- polyuria, ataxia, blurred vision, tinnitus, giddiness, jerking movements, seizures, severe hypotension, stupor, coma, respiratory complications

HOLD MEDICATION/DOSE AND NOTIFY PROVIDER

Question 6

How is lithium toxicity treated?

Answer 6

Hemodialysis - to filter the lithium out of the clients blood

Question 7

Side effects of Lithium

Answer 7

Weight gain, GI distress, fine hand tremors, dry mouth and thirst, drowsiness and fatigue, decreased appetite

Question 8

Who are most at risk for Lithium toxicity?

Answer 8

Renal Injuries or diseased
Elderly pt
Stomach flu pt (at risk for dehydration)

Question 9

Patient Education: Lithium

Answer 9

Take as prescribed
Expect weight gain (2.3kg-5lb during first week)
Takes about 2-3(4-6) weeks to start seeing results
Stay hydrated - drink 2/3 L of fluid/day
Avoid caffeine
Take Lithium with food or glass of milk
Do not lower/increase amount of Na in diet - eat an adequate amount
If you are pregnant, do not take Lithium

Question 10

Interactions (HOLD Li)

Answer 10

• NSAIDs (except for Aspirin), Tetracyclines, Diuretics - Increases risk for toxicity
• Phenothiazine antipsychotics (Haloperidol)
  increases risk for dyskinesias, urinary retention
• ACE inhibitors, may increase Li levels, increasing risk for toxicity

Question 11

Brand name for Lithium

Answer 11

Lithium carbonate or Lithobid

Question 12

Anticonvulsants/ Antiepileptic Medications

Answer 12

Valproates- Valproic acid (Depakote, Depacon, Depakene), Carbamazepine (Tegretol), Clonazepam (Klonopin), Topiramate (Topamax, Topiragen) & Lamotrigine (Lamictal)

Question 13

Valproates

Answer 13

Depako, Depacon, Depakene

Therapeutic use: treat all seizure types, controls Mania in bipolar disorder

Question 14

Adverse effects: Valproates

Answer 14

Bruising, bleeding, prolongs bleeding time, decreased platelets
GI symptoms
Skin rash
Neural tube defect (prevention is needed if pt becomes pregnant)
Hyperammonemia
Pancreatitis
Liver toxicity - may be fatal

Question 15

Patient education: Valproates

Answer 15

report bleeding or bruising to HCP
take with food
report rash to HCP
contact provider if become pregnant
Report N/V, abdominal pain, jaundice, anorexia to HCP

Question 16

Carbamazepine (Tegretol)

Answer 16

Therapeutic use: Mood stabilize in bipolar, treat tonic-clonic seizures, partial seizures

Question 17

Carbamazepine: Adverse effects

Answer 17

Visual disturbances and other CNS effects; headache, ataxia
Decrease in blood cell production
Skin rash
Epidermal necrolysis
Steven-johnson syndrome (Life threatening skin reactions, toxic skin necrolysis. Symptoms; flu-like symptoms and then follows painful blister and peeling of the skin - it starts off on the face and chest and moves elsewhere)
Photosensitvity

Question 18

Carbamazepine: Precautions

Answer 18

Cardiac or hepatic disease
HLA-B*1502 gene - found in Asian descent and increases risk of severe skin reactions
Alcohol use disorder

Question 19

Anticonvulsants: Pt education

Answer 19

Do not discontinue abruptly
Report following to HCP immediately; skin rash, unusual bleeding, spontaneous bruising, sore throat, fever, malaise, dark urine, yellow skin or eyes
Avoid alcohol or OTC medications without approval from HCP
AVOID GRAPEFRUIT

Question 20

Anticonvulsant: Nursing interventions

Answer 20

Monitor platelet counts
Monitor for Signs for infections

Question 21

Anticonvulsants: Side effects

Answer 21

CNS effects (nystagmus, double vision, vertigo, staggering gait, headache), Blood dycrasias (leukopenia, anemia, thrombocytopenia), Hyperosmolality, Skin rash, N/V, weight gain

Question 22

Calcium-channel blocker

Answer 22

Verapamil (Calan)

Therapeutic use:

Question 23

Calcium-channel blocker: Pt education

Answer 23

• AVOID GRAPEFRUIT
  Do not discontinue drug abruptly
  Take as prescribed
  Change positions slowly

Report following symptoms to provider; irregular heartbeat, chest pain, dizziness, syncope, shortness of breath, swelling of hands and feet, profound mood swing, severe and persistent headache