bipolar meds (329 E2)

Question 1

medications for acute mania

Answer 1

• mood stabilizers
• atypical antipsychotics
• benzodiazepines

Question 2

mood stabilizing drugs

Answer 2

• lithium (plus an antipsychotic)
• divalproex (plus an antipsychotic)

Question 3

atypical antipsychotics

Answer 3

• risperidone
• quetiapine
• aripiprazole
• olanzapine

Question 4

benzodiazepines

Answer 4

• diazepam
• lorazepam

Question 5

in a bipolar disorder, if we only use an antidepressant for mood stabilization, what are we putting the individual at risk for

Answer 5

a manic episode

Question 6

bipolar disorder meds for mood stabilization

Answer 6

• lithium carbonate
• anticonvulsant mood stabilizers
• second generation antipsychotics
• combination medication

Question 7

anticonvulsant mood stabilizers

Answer 7

• valproate/sodium valproate/divalproex sodium
• carbamazepine
• lamotrigine
• gabapentin (great for acute mania & rapid cycling)

Question 8

combination medication

Answer 8

symbax (olanzapine & fluoxetine)
if patient has bipolar and are typically more depressed -> bipolar 2 disorder

Question 9

lithium carbonate: indications

Answer 9

acute mania and maintenance treatment of bipolar disorder

Question 10

lithium carbonate: nursing considerations

Answer 10

need to monitor therapeutic levels

• therapeutic is 0.6-1.4
• toxic is 1.5 and above
• initial labs 1-2x per week then monitor creatinine concentrations, thyroid hormones & CBC every 7 months
• risk of kidney damage
• thyroid function may decrease so observe for dry skin, hair loss, constipation, bradycardia and cold intolerance

Question 11

lithium carbonate: contraindications

Answer 11

CVD
renal disease
brain damage
thyroid disease
pregnant
breast feeding

Question 12

lithium carbonate: expected SE

Answer 12

• N/V/D
• thirst & polyuria
• lethargy & sedation
• fine hand tremor
  if these are seen, titrate down

Question 13

lithium carbonate: early signs of toxicity

Answer 13

• GI upset
• course hand tremor
• confusion
• hyper-irritability of muscles
• electroencephalographic changes
• sedation
• incoordination

Question 14

lithium carbonate: advanced signs of toxicity

Answer 14

• ataxia
• giddiness
• serious electroencephalographic changes
• sedation
• incoordination

Question 15

lithium carbonate: severe toxicity

Answer 15

• convulsions
• oliguria
• death

Question 16

Lithium Carbonate overview

Answer 16

• most widely used mood stabilizer
• dosing: 120-300 mg/d
• onset 5 to 7 days
• crosses cell membranes, alters Na transportm not protein bound

Question 17

lithium teaching points

Answer 17

• study showed increased risk of SI when Li+ discontinued, assess for sx of depression
• do not restrict sodium in diet, maintain normal Na intake
• hydrate: child may need to take bottle water to school
• if strenuous activity leads to sweating hydrate more
• if illness causes loss of fluids, contact MD
• intermittent blood tests are required

Question 18

valproate

Answer 18

• anticonvulsant
• check serum levels
• longer periods of mood stabilization

Question 19

cabamazepine

Answer 19

• anticonvulsant
• check serum levels
• risk of low WBCs
• check hepatic and renal function
• effective in pts who have no response to lithium or w/ secondary mania
• rash may be life threatening

Question 20

lamotrigine

Answer 20

• anticonvulsant
• for rapid cycling and depressed phase of bipolar illness
  rash may be life threatening
• used as add on therapy in refractory mood disorders
  try lithium first

Question 21

gabapentin

Answer 21

• anticonvulsant
• may be effective for acute mania, mood stabilization and rapid cycling
  try lithium and lamotrigine first

Question 22

lamotrigine rash

Answer 22

stop med immediately

• flu like sx
• is an allergic reaction
• can advance to Steven Johnson Syndrome
• can further advance to toxic epidermal necrosis

Question 23

other non pharm for bipolar

Answer 23

• ECT
• teamwork & safety
• seclusion protocol
• support groups
• health teaching & promotion