23 Meds Related for Bipolar Disorder

Question 1

valproic acid

Answer 1

for treating + preventing acute mania

Question 2

valproic acid

monitor what labs?

Answer 2

liver function tests [AST/ALT]
platelet count [150k-300k]
pregnancy test

Question 3

bipolar is primarily managed with

Answer 3

mood-stabilizing medication

-lithium carbonate

Question 4

bipolar is treated with..

Answer 4

antiepileptic
antipsychotic
anxiolytic
antidepressants
mood stabilizer (primary)

Question 5

anti-epileptic meds

Answer 5

• valproic acid
• carbamazepine
• lamotrigine

Question 6

anti-epileptic meds

pharm action

Answer 6

slows entrance of Na + Ca back into neurons

• extends the time it takes for neurons to return to its active state
• incr inhibitory effects of GABA

Question 7

anti-epileptic inhibits ____ which in turn suppresses ____

Answer 7

glutamate/glutamic acid; CNS excitation

Question 8

anticonvulsants that act as mood stabilizers

Answer 8

• clonazepam
• gabapentin
• topiramate

Question 9

med administered for short-term basis for sleep impairment related to mania

Answer 9

lorazepam

Question 10

do not give ____ while in a manic state.

Answer 10

SSRI

-only for major depressive episode

Question 11

ANTIPSYCHOTICS

Answer 11

useful in early treatment

• promote sleep
• decr anxiety + agitation
• mood-stabilizing properties

Question 12

ANXIOLYTIC drugs that are also used for bipolar

Answer 12

clonazepam (also an anticonvulsant) + lorazepam (benzo, sedative)

Question 13

ANXIOLYTIC

Answer 13

useful in acute mania

-helps manage psychomotor agitation often seen in mania

Question 14

antidepressants for bipolar + their class

Answer 14

fluoxetine SSRI
bupropion ATYPICAL
venlafaxine SSNRI

Question 15

____ are prescribed with ____ to prevent rebound mania

Answer 15

antidepressant; mood stabilizer

Question 16

mood stabilizer

drug name

Answer 16

Lithium carbonate

Question 17

Lithium carbonate (mood stablzr)
pharm action

Answer 17

• serotonin receptor block
• decreases neuronal atrophy
• increases neuronal growth

Question 18

Lithium carbonate (mood stablzr)
indication

Answer 18

• treatment of bipolar
• controls acute mania
• prevents return of mania/depression
• decrease incidence of suicide

Question 19

Lithium carbonate (mood stablzr)
A/E

Answer 19

• GI distress
• fine hand tremors
• polyuria, mild thirst
• wt gain
• renal toxicity
• goiter, hypo-thyroid
• hypotension
• brady-dysrhythmia
• electrolyte imbalance

Question 20

Lithium carbonate (mood stablzr)
GI distress + nursing actions

Answer 20

nausea, diarrhea, ab pain

• usually goes away after long term use
• have w meal or milk

Question 21

Lithium carbonate (mood stablzr)
fine hand tremors + nursing actoins

Answer 21

• can be worsened w stress + caffeine
• admin beta adrenergic blockers (propranolol)
• keep dosage as low as possible, or give divided dosages
• report increased tremors> could be Li toxicity

Question 22

Lithium carbonate (mood stablzr)
polyuria, mild thirst + nursing action

Answer 22

• maintain adeq fluid intake [1.5-3L]

- use K sparing drug (spirolactone)

Question 23

Lithium carbonate (mood stablzr)
renal toxicity + nursing action

Answer 23

• monitor I+O
• adjust dosage, keep as low as possible
• assess baseline BUN + creatinine
• monitor kidney function periodically

Question 24

Lithium carbonate (mood stablzr)
goiter, hypothyroidism + nursing action

Answer 24

• w long term tx
• obtain baseline T3, T4, TSH before tx then annually
• admin levothyroxine
• monitor for signs of hypothyroid
• —cold dry skin, dect hrt rt, wt gain

Question 25

``` Lithium carbonate (mood stablzr) hypotension, brady-dysrhythmia, electrolyte imbalance + nursing action ```

Answer 25

maintain adequate fluid + Na intake

Question 26

LITHIUM TOXICITY - common a/e | less than 1.5 mEq/L

Answer 26

- diarrhea - N/V - thirst - polyuria - weakness - fine hand tremors - slurred speech - lethargy * *manifestations often improve over time

Question 27

LITHIUM TOXICITY - early indication | 1.5-2 mEq/L

Answer 27

- mental confution - sedation - poor coordination - coarse tremors - contd GI distress (N/V,diarrhea) * **withold med * **adjust new dosage based on Li + Na levels

Question 28

LITHIUM TOXICITY - advanced indication | 2-2.5 mEq/L

Answer 28

- extreme polyuria of dilute urine - tinnitus - giddiness - jerky movements - blured vision - ataxia - seizure - severe hypotension - stupor>coma - resp complication> death * **admin emetic or gastric lavage

Question 29

_____ may be prescribed during advanced indication of lithium toxicity to increase rate of excretion

Answer 29

- urea - mannitol - aminophylline

Question 30

LITHIUM TOXICITY - severe indication | 2.5+ mEq/L

Answer 30

- rapid progression leading to coma/death | * **hemodialysis

Question 31

``` Lithium carbonate (mood stablzr) CI ```

Answer 31

- pregnancy esp 1st trimester - breastfeeding - severe renal disease - severe cardiac disease - hypovolemia - schizophrenia - --caution w thyroid, seizure, diabetes issues

Question 32

NSAID + Li

Answer 32

incr renal absorption of lithium | >toxicity

Question 33

``` Lithium carbonate (mood stablzr) nursing admin ```

Answer 33

- effects begin 55-7 days - 2-3x/day bc short half life - food helps w GI distress - older adults at risk of toxicity

Question 34

how often + when should Li levels be obtained?

Answer 34

- monitor Li levels Q2-3days until stable - ---then Q1-2months - in morning, 10-12 hrs after last dose

Question 35

Li therapeutic range

Answer 35

acute mania [1-1.5mEq] | maintenance [0.6-1.2]

Question 36

anti-epileptic meds [valproic acid, carbamazepine, lamotrigine] indication

Answer 36

- treat + prevent relapse of manic/depress | - esp useful in mixed mania or rapid cycling bipolar

Question 37

norm AST/ALT, amylase

Answer 37

AST: 0-35 U/L ALT: 4-36 U/L amy:40-140 U/L

Question 38

valproic acid | A/E

Answer 38

- GI effects [n/v, indigestion] - hepatotoxicity [anorexia, n/v, fatigue, jaundice] - pancreatitis [n/v, ab pain] - THROMBOCYTOPENIA - TERATOGENESIS - WT GAIN

Question 39

therapeutic range for valproic acid

Answer 39

50-120 mcg/mL

Question 40

therapeutic range for carbamazepine

Answer 40

4-12 mcg/mL