Ch 34 Bi Polar Drugs

Front 1

What is the typical manifestation and clinical time line for bipolar disorder?

Back 1

alternating between manic and depressive states with period of normal mixed in there.

There are 4 types of mood episodes.

Front 2

What is the best way to determine therapeutic lithium levels?

Back 2

Lithium has a low therapeutic index. As a result, toxicity can occur at blood levels only slightly greater than therapeutic levels. Accordingly, monitoring lithium levels is mandatory.

The trough level, measured 12 hours after the evening dose, should be less than 1.5 mEq/L.
0.8 to 1.4 mEq/L for acute therapy

• When plasma levels exceed 1.5 mEq/L, more serious toxicities appear. At drug levels above 2.5 mEq/L, death can occur. Patients should be informed about early signs of toxicity and instructed to interrupt lithium dosing if these appear.

In adherent patients, the most common cause of lithium accumulation is sodium depletion.

Front 3

how and why are body sodium balance is important in maintaining steady blood lithium levels and responses to the drug?

Back 3

A reduction in sodium levels will reduce lithium excretion, causing lithium to accumulate—possibly to toxic levels. Patients must maintain normal sodium intake and levels.

Front 4

What are some drug and diet related habits that affect lithium levels?

Back 4

sodium intake and NSAIDS both cause the excretion of Lithium to slow down to dangerous levels.

Front 5

What are the four types of mood episodes that Bipolar patients could expereience?

Back 5

o Pure manic episode: Manic episodes are characterized by persistently heightened, expansive, or irritable mood—typically associated with hyperactivity, excessive enthusiasm, and flight of ideas.
o Hypomanic depressive episode: Hypomania can be viewed as a mild form of mania. As in mania, mood is persistently elevated, expansive, or irritable.
o Major depressive episode: A major depressive episode is characterized by depressed mood and loss of pleasure or interest in all or nearly all of one’s usual activities and pastimes.
o Mixed episode: In a true mixed episode, patients experience symptoms of mania and depression simultaneously. Patients may be agitated and irritable (as in mania) but may also feel worthless and depressed. The combination of high energy and depression puts them at significant risk of suicide.

Front 6

What three types of drugs is Bipolar disorder treated with?

Back 6

Bipolar disorder is treated with three kinds of drugs: mood stabilizers, antipsychotic drugs, and antidepressants.

Front 7

What drugs are used to treat acute episodes of bipolar disorder?

Long term?

Back 7

Mood stabilizers or a mood stabilzer + antidepressant.

More than one mood stabilizer is used in long term treatment

Front 8

Why are antidepressant alone not used to treat bi polar disorder?

Back 8

using an antidepressant alone may induce mania so they are usually paired with a mood stabilizer

Front 9

What are the three main pharmacotherapeutic functions of Mood stabilizers in tx of bi polar disorder?

Back 9

(1) relieve symptoms during manic and depressive episodes;
(2) prevent recurrence of manic and depressive episodes; and
(3) do not worsen symptoms of mania or depression, and do not accelerate the rate of cycling.

Front 10

What are the preferred mood stabilizers for tx of bi polar disorder?

and which situation is each reserved for?

Back 10

Lithium and Valproic Acid

Carbemazepine is another option but not as popular

Lithium is reserved primarily for patients with classic (euphoric) mania;
valproic acid is generally preferred for all other patients.

Omega 3 fish oil can also be used but this means the patient must decrease Omega 6 which negates the effects of Omega 3.

Front 11

What is the time course when using Lithium to treat bipolar disorder?

Back 11

• Antimanic effects begin 5 to 7 days after treatment onset—but full benefits may not develop for 2 to 3 weeks.

Front 12

What are some common side effects that occur at therapeutic Lithium levels?

Back 12

Common side effects that occur at therapeutic lithium levels include tremor, goiter, and polyuria.

Front 13

Lithium drugs may be ______?

Back 13

teratogenic

Front 14

What was the first antiseizure med approved for use in BI polar disorder?

Back 14

Valproic acid (Depakene, Depakote, Depacon)

Front 15

Although Valproic acid has a higher therapeutic index than Lithium, how dangerous is it and what can occur at toxic levels?

Back 15

it can cause serious toxicity. Of greatest concern are rare cases of thrombocytopenia, pancreatitis, and liver failure—all of which require immediate drug withdrawal.

Front 16

What is the indication for anti psychotics in tx of BPD?

Back 16

are used acutely to treat manic episodes and long term to help prevent mood episodes. Benefits occur in patients with and without psychotic symptoms.

Front 17

What are the two groups of antipsychotics used? Which are preferred for BPD?

Back 17

conventional agents (eg, haloperidol) and atypical agents (eg, olanzapine).

The atypicals are preferred

Front 18

Which 5 atypicals are approved for BPD?

Back 18

• Five agents are approved for BPD
o Olanzapine (Zyprexa)
o Quetiapine (Seroquel)
o Risperidone (Risperdal)
o Aripiprazole (Abilify)

the most popular are Olanzepine and Risperdal for this condition
o Ziprasidone (Geodon)

Front 19

In BPD...
Many pts also receive an _____?
Some pts also require an

Back 19

antipsychotic med.

Front 20

In BPD ...
Some pts also require an______?

Back 20

antidepressant med.

Front 21

What is the DOC for tx of BPD?

Back 21

Valproic Acid

Front 22

Who are considered high risk patients for lithium therapy?

Back 22

Pregnant women (esp 1st trimester)
Pts with renal & CV disease; dehydration, sodium depletion and those concurrently taking diuretics.

Front 23

What can the nurse advise pts to decrease gastric upset when taking lithium?

Back 23

Take drug with meals or milk.

Front 24

What will the nurse teach the pt about causes of lithium accumulation?

Back 24

Kidney function should be monitored yearly.
Maintain a normal sodium intake.
Diarrhea can cause significant sodium loss.
Use diuretics with caution.

Front 25

What can the nurse tell the pt to do to counteract the polyuria that occurs with lithium treatment?

Back 25

Instruct pts to drink 8 to 12 glasses of fluid daily to maintain hydration.

Front 26

A patient with bipolar disorder is taking lithium. Which of the
following signs and symptoms exhibited by the patient would
indicate lithium toxicity

Back 26

Polydipsia, slurred speech, and fine hand tremors

Front 27

A patient with bipolar disorder is taking lithium. Which statement made by the patient indicates a need for further teaching?

Back 27

“I will restrict my sodium intake while taking this medication.”

Front 28

When administering lithium carbonate, which of the following assessments would indicate that therapy has achieved the desired effect?

Back 28

controlling the manic episodes but not causing sedation.

Front 29

A patient has decided to try fish oil to treat her BPD. It is important for this patient to decrease intake of:

Back 29

vegetable oils which have Omega 6 fatty acids

Front 30

What are the other actions taken in tx of BPD besides drug therapy?

Back 30

Psychotherapy and education ( maintaining stable sleep pattern, regular pattern of activity, avoiding alcohol and psychoactive drugs, support, reducing stress, keeping a mood log to monitor progress)

ECT