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58 Cards in this Set

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Bipolar primarily managed with?
Mood stabilizing medications - lithium carbonate
Bipolar can also be treated with certain antiepileptic medications such as (3)
Valproic acid
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Atypical Antipsychotics-
can be useful in early treatment to promote sleep and to decrease anxiety and agitation. These meds also demonstrate mood stabilizing properties.
Anxiolytics
Clonazepam (Klonodine) and lorazepam (Ativan) can be useful in treating acute mania and managing the psychomotor agitation often seen in mania
Mood Stabilizer - Lithium Carbonate -->Expected Pharm Action
Lithium produces neurochem changes in brain - including serotonin receptor blockade
Evidence that lithium decrease neural atrophy and/or increases neuronal growth
Mood Stabilizer - Lithium Carbonate therapeutic Uses
Used in treatment of bipolar disorders. Lithium controls episodes of acute mania, helps to prevent the return of mania or depression, and decreases the incidence of suicide.
Mood Stabilizer - Lithium Carbonate Other Uses
Alcoholism
Bulimia
Schizophrenia
Mood Stabilizer - Lithium Carbonate Side Effects
GI distress, Fine hand tremors that can interfere w/purposeful motor skills and can be exacerbated by factors such as stress and caffeine, polyuria+mild thirst, wt gain, renal toxicity, goiter/hypothyroidusm, bradydysrhythmias, hypotension, electrolyte imbalances
Mood Stabilizer - Lithium Carbonate NI GI distress
- advise the PT that symptoms are usually transient
- Admin med w/meals or milk
Mood Stabilizer - Lithium Carbonate NI Fine Hand Tremors [can interfere w/purposeful motor skills)
-Administer BB agents such as propranolol (inderal)
-Adjust dose dosage to be as low as possible, given in divided doses, or use long-acting formulations
-Advise PT to report to an increase in tremors, which could be a sign of lithium toxicity
Mood Stabilizer - Lithium Carbonate NI: Polyuria + mild thirst
-Use potassium-sparing diuretic, such as sprionolactone (aldactone)
-Instruct PT to maintan adequate fluid intake 2-3L
Mood Stabilizer - Lithium Carbonate Renal Toxicity --> NI
Monitor I and O
Adjust dosage, and keep dose at the lowest level necessary
Assess baseline BUN +creatinine, and monitor kidney function periodically
Mood Stabilizer - Lithium Carbonate Goiter+Hypothyroidism-->NI
-Obtain PT baseline T3,T4, and TSH levels prior to starting treatment and then annually
-Advise PT to monitor signs of hypoththyroidism (cold, dry skin; decreased HR, wt gain)
-Admin levothyroxine (Synthroid) to manage hyperthyroidism
Mood Stabilizer - Lithium Carbonate NI - Bradydysrhythmias, hypotension, electrolyte imbalances
Encourage adequate fluid intake
Early: Signs and Symptoms of Toxicity (Lithium)
-Less than 1.5 mEq/L
-Diarrhea, nausea, vomitting, thirst, polyuria, muscle weakness + slurred speech

*Instruct PT to d/c medication, and notify MD
Administer new dosage based on PT's serium lithium levels
Advanced: Signs and Symptoms of Toxicity (Lithium)
1.5 - 2.0 mEq/L
Mental confusion, poor coordination, coarse tremors, and ongoing GI distress including nausea, vomiting, and diarrhea

*Instruct PT to d/c the medication, and notify MD
Administer new dosage based on PTs serum sodium level
Excretion may need to be promoted
Severe Toxicity: Signs and Symptoms of Toxicity (Lithium)
Greater than 2.0 - 2.5 mEq/L
Extreme polyuria of dilute urine, tinnitus, blurred vision, ataxia, seizures, severe hypotension leading to coma, and possible death from respiratory complications

Administer an emetic to alert clients, or administer gastric lavage
Urea, mannitol, or aminphylline may be prescribed to increase rate of excretion
Greater than 2.5 mEq/L - Signs and Symptoms of Toxicity (Lithium)
Rapid progression of symptoms leading to coma and death

Hemodialysis may be warranted
Contraindications Lithium
-Preg cat D - considered teratogenic - especially during 1st trimester
-Discourage PTs from breastfeeding if lithium therapy is necessary
-Use cautiously in clients with renal dysfunction, heart disease, sodium depletion, and dehydration
Medication/Food Interactions --> Diuretics
Sodium is excreted witht he use of diuretics; with decreased serum sodium, lithium excretion is decreased - which can lead to toxicity
Medication/Food Interactions --> Diuretics NI
Monitor the pT for signs of toxicity
Advise PT to observe for symptoms and to notify provider
Ecourage fluids 2-3L
Medication/Food Interactions --> NSAIDS (ibuprofen/celebrex)
Concurrent use will increase renal reabsorption of lithium, leading to toxicity
Medication/Food Interactions --> NSAIDS (ibuprofen/celebrex) NI
Avoid use of NSAIDS to prevent toxic accumulation of lithium
Use aspirin as a mild analgesic
Medication/Food Interactions --> Anticholinergics
(antihistamine, TCA) abdominal discomfort can results from anticholinergic-induced urinary retention and polyuria
Medication/Food Interactions --> Anticholinergics NI
Advise PT to avoid medications with anticholinergic effects
Lithium Nursing Administration
Monitor plasma lithium levels while undergoing treatment. At initiation of treatment, monitor levels every 2-3 days until stable, and then every 1 - 3 months. Lithium blood levels should be obtained in morning - usually after 12 hr dose
Levels:
During initial treatment of a manic episode
Maintenance level range is btw
Plasma Levels
1.) 0.8- 1.4 mEq/L
2.) 0.4 - 1.0 mEq/L
3.) >1.5 mEq/L can result in toxicity
Effects begin with in? (Lithium)
7 - 14 days
This medicine has a short or long half life?
Short - must be administered in 2-3 doses daily, due to short-half life.
Mood-Stabilizing Antiepileptic Drugs (AEDs)
Carbamazepine (Tegretol)
Valporic aci (depakote)
Lamotrigne (Lamictal)
Mood-Stabilizing Antiepileptic Drugs (AEDs) Pharm Action
- Slowing entrance of sodium and calcium back into neuron, thus extending time it takes for the nerve to return to its active state
Potentiating inhibitory effects of gamma butyric acid (GABA)
Inhibiting glutamic acid (glutamate) which in turn suppresses CNS excitation
Mood-Stabilizing Antiepileptic Drugs (AEDs) Therapeutic Uses
Used to treat manic and depressive episodes, as well as to prevent relapse of mania and depressive episodes. They are particularly useful for PTs w/mixed mania and rapid cycling bipolar disorders
Carbamzepine (Tegretol-AED) CNS effects
nystagmus, double vision, vertigo, staggering gait, headache
Carbamzepine (Tegretol - AED) CNS effects Nursing Intervention (NI)
-Administer low dosage first then gradually increase
-Advise symptoms should subsdie in few weeks
Admin dose at HS
Carbamzepine (Tegretol - AED) Side Effect - Blood Dyscrasias (leukopenia, anemia, thrombocytopenia) Nursing Interventions [ni]
-Obtain baseline CBC and platelets. Perform ongoing monitoring of these
-Observing for bruising and bleeding of gums
Carbamzepine (Tegretol - AED) Teratogenisis
Don't use while pregnant
Carbamzepine (Tegretol - AED) Hypo-osmolarty Side effect
Promotes secretion of ADH, which inhibits water excretion by the kidneys, and places PT w/HF at risk for fluid overload
Carbamzepine (Tegretol - AED) Hypo-osmolarty Side effect NI
Monitor serum sodium
Monitor for edema, decrease in urine output, and hypertension
Carbamzepine (Tegretol - AED) Skin diSORDERS NI
(Dermatitis, rash)
-Treat mild reactions w/anti-inflammatory or anithistamine meds
-Advise pT to wear sunscreen
-Instruct PT to d/cthe med and notify provider if Steve-Johnson rash occurs
Valproic Acid (Depakote) GI Effects NI
Nausea, vomitting, and indigestion

-Advise symptoms are generally self-limiting
-Advise PT to take med w/food or switch to enteric coated formulations
Valproic Acid (Depakote) Hepatotoxicity (what too look for)
Anorexia, nausea, vomiting, faitgue, abdominal pain, jaundice
Valproic Acid (Depakote) Hepatotoxicity NI
-Assess baseline liver function, and monitor liver function regularly
-Advise PT to observe for signs and symptoms of hepatotoxicity and to notify MD immediately if occur
-Avoid using in younger than 2
Admin lowest effective dose
Valproic Acid (Depakote)Pancreatitis S/S
nausea, vomiting, abdominal pain
Valproic Acid (Depakote) Pancreatitis NI
Advise PT to observe for s/s of pan and to notify MD ASAP if occur
-Monitor PT amylase levels
-Monitor platelet counts
Valproic Acid (Depakote) Thrombocytopenia NI
Advise PT to observe for S/S - bruising and notify MD
-Monitor platelet counts
Valproic Acid (Depakote)Teratogenesis
don't take while pregnant
Lamotrigine (Lamictal) Side Effects - eyes
double or blurred vision, dizziness, headache, n/v
Lamotrigine (Lamictal) Side Effects - eyes NI
Caution PT about performing activities that require concentration
Lamotrigine (Lamictal) Side Effects - serious skin rashes, including stevens-johnson syndrome NI
Instruct PT to d/c the med, and notify MD if a rash occurs
Carbmazepine and PTs w/bone marrow suppression/bleeding disorders?
CONTRAINDICATED!!
Valporic Acid Contraindicated in?
PTs w/liver disorders
Med/Food Interactions: Carbamazepine + orcal contraceptives and warfarin
Concurrent use of this med causes a decrease in effects in these medications due to stimulation of hepatic and drug metabolizing enzymes

-Advise PT to use different form of BC
-Monitor for therapeutic effects of warfarin, dosage may need to be adjusted
Med/Food Interactions: Carbamazepine + grapefruit juice
Inhibits metabolism of carmazepin, thereby increasing blood levels of the medication

avise PT to avoid all intake of grapefruit juice
Med/Food Interactions: Carbamazepine + Phenytoin/phenobarbital
Concurrent use decreases the effects of this drug by stimulating metabolism

-Monitor phnytoin and phenobarbital levels and adjust dosage as needed
Med/Food Interactions: Valproic Acid (Depakote) + Phenytoin/phenobarbital
Concurrent use increases levels of tehse medications

Monotir levels and adjust dosage as prescribed
Med/Food Interactions - Lamotrigne (Lamictal) + carbamazepine, Phenytoin/phenobarbital
Concurrent use promotes liver-drug metabolizing enzymes, thereby decreasing the effect of lamotrigne

Monitor for therapy effects, and adjust dosage as prescribed
Med/Food Interactions - Lamotrigne (Lamictal) + Valporic Acid
concurrent use inhibits drug-metablozing enzymes, thereby increasing the half-life of lamotrigne

Monitor for adverse effects, adjust dosage as prescribed
Mood-Stablizing Antiepileptic Drugs (AEDs)effectiveness Evidenced BY
-Relief of acute manic symptoms (flight of ideas, obsessive talking, agitation) or depressive symptoms - fatigue, poor appetite, psychomotor retardation)
-Says improvement in mood
-Ability to perform ADLS
Improved sleeping/eating habits
-Greater interaction w/peers