Ati Psych Ch. 21 Medications For Bipolar Disorders

Front 1

Bipolar primarily managed with?

Back 1

Mood stabilizing medications - lithium carbonate

Front 2

Bipolar can also be treated with certain antiepileptic medications such as (3)

Back 2

Valproic acid
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)

Front 3

Atypical Antipsychotics-

Back 3

can be useful in early treatment to promote sleep and to decrease anxiety and agitation. These meds also demonstrate mood stabilizing properties.

Front 4

Anxiolytics

Back 4

Clonazepam (Klonodine) and lorazepam (Ativan) can be useful in treating acute mania and managing the psychomotor agitation often seen in mania

Front 5

Mood Stabilizer - Lithium Carbonate -->Expected Pharm Action

Back 5

Lithium produces neurochem changes in brain - including serotonin receptor blockade
Evidence that lithium decrease neural atrophy and/or increases neuronal growth

Front 6

Mood Stabilizer - Lithium Carbonate therapeutic Uses

Back 6

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.

Front 7

Mood Stabilizer - Lithium Carbonate Other Uses

Back 7

Alcoholism
Bulimia
Schizophrenia

Front 8

Mood Stabilizer - Lithium Carbonate Side Effects

Back 8

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

Front 9

Mood Stabilizer - Lithium Carbonate NI GI distress

Back 9

- advise the PT that symptoms are usually transient
- Admin med w/meals or milk

Front 10

Mood Stabilizer - Lithium Carbonate NI Fine Hand Tremors [can interfere w/purposeful motor skills)

Back 10

-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

Front 11

Mood Stabilizer - Lithium Carbonate NI: Polyuria + mild thirst

Back 11

-Use potassium-sparing diuretic, such as sprionolactone (aldactone)
-Instruct PT to maintan adequate fluid intake 2-3L

Front 12

Mood Stabilizer - Lithium Carbonate Renal Toxicity --> NI

Back 12

Monitor I and O
Adjust dosage, and keep dose at the lowest level necessary
Assess baseline BUN +creatinine, and monitor kidney function periodically

Front 13

Mood Stabilizer - Lithium Carbonate Goiter+Hypothyroidism-->NI

Back 13

-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

Front 14

Mood Stabilizer - Lithium Carbonate NI - Bradydysrhythmias, hypotension, electrolyte imbalances

Back 14

Encourage adequate fluid intake

Front 15

Early: Signs and Symptoms of Toxicity (Lithium)

Back 15

-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

Front 16

Advanced: Signs and Symptoms of Toxicity (Lithium)

Back 16

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

Front 17

Severe Toxicity: Signs and Symptoms of Toxicity (Lithium)

Back 17

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

Front 18

Greater than 2.5 mEq/L - Signs and Symptoms of Toxicity (Lithium)

Back 18

Rapid progression of symptoms leading to coma and death

Hemodialysis may be warranted

Front 19

Contraindications Lithium

Back 19

-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

Front 20

Medication/Food Interactions --> Diuretics

Back 20

Sodium is excreted witht he use of diuretics; with decreased serum sodium, lithium excretion is decreased - which can lead to toxicity

Front 21

Medication/Food Interactions --> Diuretics NI

Back 21

Monitor the pT for signs of toxicity
Advise PT to observe for symptoms and to notify provider
Ecourage fluids 2-3L

Front 22

Medication/Food Interactions --> NSAIDS (ibuprofen/celebrex)

Back 22

Concurrent use will increase renal reabsorption of lithium, leading to toxicity

Front 23

Medication/Food Interactions --> NSAIDS (ibuprofen/celebrex) NI

Back 23

Avoid use of NSAIDS to prevent toxic accumulation of lithium
Use aspirin as a mild analgesic

Front 24

Medication/Food Interactions --> Anticholinergics

Back 24

(antihistamine, TCA) abdominal discomfort can results from anticholinergic-induced urinary retention and polyuria

Front 25

Medication/Food Interactions --> Anticholinergics NI

Back 25

Advise PT to avoid medications with anticholinergic effects

Front 26

Lithium Nursing Administration

Back 26

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

Front 27

Levels:
During initial treatment of a manic episode
Maintenance level range is btw
Plasma Levels

Back 27

1.) 0.8- 1.4 mEq/L
2.) 0.4 - 1.0 mEq/L
3.) >1.5 mEq/L can result in toxicity

Front 28

Effects begin with in? (Lithium)

Back 28

7 - 14 days

Front 29

This medicine has a short or long half life?

Back 29

Short - must be administered in 2-3 doses daily, due to short-half life.

Front 30

Mood-Stabilizing Antiepileptic Drugs (AEDs)

Back 30

Carbamazepine (Tegretol)
Valporic aci (depakote)
Lamotrigne (Lamictal)

Front 31

Mood-Stabilizing Antiepileptic Drugs (AEDs) Pharm Action

Back 31

- 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

Front 32

Mood-Stabilizing Antiepileptic Drugs (AEDs) Therapeutic Uses

Back 32

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

Front 33

Carbamzepine (Tegretol-AED) CNS effects

Back 33

nystagmus, double vision, vertigo, staggering gait, headache

Front 34

Carbamzepine (Tegretol - AED) CNS effects Nursing Intervention (NI)

Back 34

-Administer low dosage first then gradually increase
-Advise symptoms should subsdie in few weeks
Admin dose at HS

Front 35

Carbamzepine (Tegretol - AED) Side Effect - Blood Dyscrasias (leukopenia, anemia, thrombocytopenia) Nursing Interventions [ni]

Back 35

-Obtain baseline CBC and platelets. Perform ongoing monitoring of these
-Observing for bruising and bleeding of gums

Front 36

Carbamzepine (Tegretol - AED) Teratogenisis

Back 36

Don't use while pregnant

Front 37

Carbamzepine (Tegretol - AED) Hypo-osmolarty Side effect

Back 37

Promotes secretion of ADH, which inhibits water excretion by the kidneys, and places PT w/HF at risk for fluid overload

Front 38

Carbamzepine (Tegretol - AED) Hypo-osmolarty Side effect NI

Back 38

Monitor serum sodium
Monitor for edema, decrease in urine output, and hypertension

Front 39

Carbamzepine (Tegretol - AED) Skin diSORDERS NI

Back 39

(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

Front 40

Valproic Acid (Depakote) GI Effects NI

Back 40

Nausea, vomitting, and indigestion

-Advise symptoms are generally self-limiting
-Advise PT to take med w/food or switch to enteric coated formulations

Front 41

Valproic Acid (Depakote) Hepatotoxicity (what too look for)

Back 41

Anorexia, nausea, vomiting, faitgue, abdominal pain, jaundice

Front 42

Valproic Acid (Depakote) Hepatotoxicity NI

Back 42

-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

Front 43

Valproic Acid (Depakote)Pancreatitis S/S

Back 43

nausea, vomiting, abdominal pain

Front 44

Valproic Acid (Depakote) Pancreatitis NI

Back 44

Advise PT to observe for s/s of pan and to notify MD ASAP if occur
-Monitor PT amylase levels
-Monitor platelet counts

Front 45

Valproic Acid (Depakote) Thrombocytopenia NI

Back 45

Advise PT to observe for S/S - bruising and notify MD
-Monitor platelet counts

Front 46

Valproic Acid (Depakote)Teratogenesis

Back 46

don't take while pregnant

Front 47

Lamotrigine (Lamictal) Side Effects - eyes

Back 47

double or blurred vision, dizziness, headache, n/v

Front 48

Lamotrigine (Lamictal) Side Effects - eyes NI

Back 48

Caution PT about performing activities that require concentration

Front 49

Lamotrigine (Lamictal) Side Effects - serious skin rashes, including stevens-johnson syndrome NI

Back 49

Instruct PT to d/c the med, and notify MD if a rash occurs

Front 50

Carbmazepine and PTs w/bone marrow suppression/bleeding disorders?

Back 50

CONTRAINDICATED!!

Front 51

Valporic Acid Contraindicated in?

Back 51

PTs w/liver disorders

Front 52

Med/Food Interactions: Carbamazepine + orcal contraceptives and warfarin

Back 52

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

Front 53

Med/Food Interactions: Carbamazepine + grapefruit juice

Back 53

Inhibits metabolism of carmazepin, thereby increasing blood levels of the medication

avise PT to avoid all intake of grapefruit juice

Front 54

Med/Food Interactions: Carbamazepine + Phenytoin/phenobarbital

Back 54

Concurrent use decreases the effects of this drug by stimulating metabolism

-Monitor phnytoin and phenobarbital levels and adjust dosage as needed

Front 55

Med/Food Interactions: Valproic Acid (Depakote) + Phenytoin/phenobarbital

Back 55

Concurrent use increases levels of tehse medications

Monotir levels and adjust dosage as prescribed

Front 56

Med/Food Interactions - Lamotrigne (Lamictal) + carbamazepine, Phenytoin/phenobarbital

Back 56

Concurrent use promotes liver-drug metabolizing enzymes, thereby decreasing the effect of lamotrigne

Monitor for therapy effects, and adjust dosage as prescribed

Front 57

Med/Food Interactions - Lamotrigne (Lamictal) + Valporic Acid

Back 57

concurrent use inhibits drug-metablozing enzymes, thereby increasing the half-life of lamotrigne

Monitor for adverse effects, adjust dosage as prescribed

Front 58

Mood-Stablizing Antiepileptic Drugs (AEDs)effectiveness Evidenced BY

Back 58

-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