Mood Stabilizers Flashcards

1
Q

Lithium Contraindication

A

Liver/Renal dz, pregnant/lactating, severe CVD/dehydration, brain tumor/damage, Na+ depletion, children<12yo; Caution with TSH dz

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2
Q

Lithium Drug-Food interaction

A

Increase Na+ intake, as lithium can deplete Na+

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3
Q

Lithium Drug-Drug interaction

A

Lithium higher with thiazide diuretics, methyldopa, haloperidol, NSAIDs, antidepressants, carbamazepine, theophylline, aminophylline, sodioum bicarbonate, phenothiazine

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4
Q

Lithium Lab effects

A

Increase blood/urine glucose/protein; decrease serum Na+

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5
Q

Lithium S/E

A

HA, lethargy, drowsiness, dizziness, tremors, slurred speech, dry mouth, anorexia, vomitting, diarrhea, polyuria, hypotension, abd pain, muscle weakness, restlessness

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6
Q

Lithium A/E

A

Urinary incontinence (check for fluid deficit d/t polyuria), hyponatremia, clonic movements, stupor, azotemia (high waste: BUN, Cr), leukocytosis, nephrotoxicity

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7
Q

Lithium life-threatening effect

A

cardiac dysrhythmias, circulatory collapse (failure to deliver/take away O2, nutrients, wastes to/from tissues)

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8
Q

Who can’t have Lithium?

A

pts with suicidal ideation

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9
Q

Evaluate what s/s for lithium?

A

neurologic status, gait, LOC, reflexes, tremors

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10
Q

What labs do run/check for lithium? How often to run?

A

LFTs, RFTs; draw weekly intitially then q 1-2mon

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11
Q

s/s of lithium toxicity at 1.5-2.0 mEq/L; what do you do?

A

MILD toxicity at 2.0 : N/V/D, ataxia, blurred, tinnitus; Do: increase Na or decrease dose

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12
Q

s/s of lithium toxicity at 2-3.5 mEq/L. What do you do?

A

Moderate toxicity at 3.0: excessive UO of dilute urine, increasing tremors, muscular irritability, psychomotor retardation, confusion, giddiness. Give NS d/t pt need salt.

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13
Q

s/s of lithium toxicity at 3.5+ mEq/L; what do you do?

A

LIFE THREATENING: impaired consciousness, nystagamus, seizures, coma, oliguria/anuria, cardiac dysrhythmias, myocardial infarction, cardiovascular collapse. Hold meds and notify MD. Pt needs ICU or dialysis

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14
Q

Evaluate what sort of drug history for pt on lithium? Why?

A

diuretics, NSAIDs, tetracyclines, methyldopa, probenecids cause decreased renal clearance and accumulation of lithium

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15
Q

depressive s/s

A

mood changes, insomnia, apathy, lack of interest in activities

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16
Q

Teach what about lithium

A

if stopped, manic s/s will reappear. Adhere to follow-up visits to check levels and drug efficacy. Notify MD r/t OTC. No dangerous mechanical activity until Lithium level is established. Fluid intake of 2-3L/day initially then 1-2L/day maintenance; increase H2O during hot weather. Take with meals for less GI irritation. See effectiveness of lithium start in 1-2 wks. Report to MD if planning to conceive d/t teratogenic effects on fetus. Wear a bracelet r/t lithium Rx. Avoid caffeine d/t aggrevate manic phase of bipolar d/o. Adequate Na intake. No crash diets. Early s/s of toxicity: diarrhea, drowsiness, loss of appetite, muscle weakness, n/v, slurred speech, trembling. Late s/s of toxicity: blurred vision, confusion, increased urination, convulsions, severe trembling, unsteadiness.

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17
Q

If lithium is stopped,

A

manic s/s will reappear.

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18
Q

tell pt to adhere to

A

follow-up visits to check levels, labs, drug efficacy.

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19
Q

Notify MD about

A

OTC, early/late s/s of toxicity, if planning pregnancy d/t teratogenic effects on fetus

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20
Q

how much fluid should pt on lithium take?

A

2-3L/day initially then 1-2L/day maintenance; increase fluids during hot weather.

21
Q

take lithium with

A

meals to decrease GI irritation

22
Q

Avoid what with lithium

A

caffeine d/t aggravation of manic phase, crash diets d/t sodium depletion; operating dangerous mechanical acitivity until lithium levels are stable

23
Q

When do you see lithium start to take effect?

A

1-2 weeks after start of tx.

24
Q

Early s/s to report with lithium

A

diarrhea, drowsiness, loss of appetite, muscle weakness, nausea, vomitting, slurred speech, trembling

25
Q

late s/s to report with lithium

A

blurred vision, confusion, increased urination, convulsions, severe trembling, unsteadiness

26
Q

when do pts stop taking lithium?

A

when pt has period of emotional stability

27
Q

pharmacokinetics of lithium

A

mets in liver; most excreted unchanged in urine

28
Q

what can you use in place of lithium?

A

anticonvulsants such as carbamazepine tegretol, lamotrigine lamictal, divaproex/valproic acid depakote/kene, gabapentin (neurontin)

29
Q

continuous lithium + NSADs =

A

cardiac sick sinus rhythm

30
Q

with lithium, if Na is up

A

lithium is down

31
Q

with lithium, if lithium is up

A

Na is down

32
Q

half life of lithium

A

24 hrs

33
Q

half life of lithium for elderly

A

36 hrs, so look for cumulative drug action

34
Q

lithium treats

A

bipolar manic depressive psychosis, manic episodes

35
Q

lithium action

A

alter ion transport in muscle/nerve cells; increased receptor sensitivity to serotonin

36
Q

valproic acid depakote/kene a/e

A

CNS depression, hepatotoxicity

37
Q

valproic acid depakote/kene therapeautic range for acute mania

A

50-125mcg/mL in blood serum

38
Q

valproic acide depakote/kene MAX dose

A

60mg/kg/day

39
Q

at what level does valproic acid depakote/kene cause CNS depression

A

200mcg/mL

40
Q

at what level does valproic acid depakote/kene cause multiorgan toxicity

A

400mcg/mL

41
Q

what is the antidote for valproic acid depakote/kene?

A

L-carnitine

42
Q

L-carnitine is an antidote for?

A

valproic acid depakote/kene

43
Q

at what level does valproic acid depakote/kene kill?

A

750+ mcg/mL

44
Q

carbamazepine tegretol treats

A

bipolar I, acute mania or mixed episode

45
Q

what are a/e of carbamazepine tegretol?

A

hyper/hypotension, PRURITIC RASH, Steven-Johnson Syndrome skin slough off (tx like burn pt), Toxic Epidermal necrolysis targetoid lesion (red/raw); nephrotoxicity (THE KIDNEY GOES 1ST), hyponatremia (s/s confusion, seizure at 119)

46
Q

lamotrigine lamictal treats

A

maintenance tx for mania

47
Q

lamotrigine lamictal life threatening s/s

A

RASH; Steven-Johnson Syndrome skin slough off, Toxic epidermal necrolysis targetoid lesion (red/raw); tx like burn pt

48
Q

List two types of mood stabilizers

A

lithium and off label use of anticonvulsants

49
Q

why would pt NOT want to take mood stabilizers

A

they want to keep their highs