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Psych Final > Bipolar 1 & 2 > Flashcards

Bipolar 1 & 2 Flashcards

1
Q

What are 4 classifications of drugs used to treat mania?

A

Antipsychotics
Anticonvulsants
Anti-anxiety
Lithium

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2
Q

What does Lithium do to treat mania?

A

It is a mood stabilizer and it may take weeks to work.

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3
Q

What do antipsychotics do for mania?

A

Brings mania down quickly, in several days.

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4
Q

What do anticonvulsants do for mania?

A

Act as mood stabilizers.

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5
Q

When are anti-anxiety meds used for mania?

A

They are used if other medications can not be used.

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6
Q

What is Lithium Carbonate, and what is it used for?

A

A natural salt, that is used for the treatment of bipolar disorder?

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7
Q

What is the therapeutic blood level of lithium carbonate?

A

0.8 to 1.4 mEq/L

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8
Q

What is the toxic blood level for Lithium carbonate?

A

1.5 mEq/L and above

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9
Q

What is the maintains blood level of Lithium carbonate for the treatment of mania and depression?

A

0.4 to 1.3 mEq/L

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10
Q

What is the therapeutic mg dosage of Lithium?

A

300-2700 mg/day

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11
Q

What are the adverse side effects of Lithium?

A

Lithium toxicity and death

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12
Q

What are the contraindications for Lithium?

A

Pregnancy & breastfeeding

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13
Q

What is important to know about children and Lithium?

A

It is toxic and should not be given to the,

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14
Q

What does Lithium do for thirst and dehydration ?

A

Increases thirst and dehydration?

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15
Q

When taking lithium what does dehydration lead to?

A

Lithium retention and toxicity

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16
Q

What does caffeine do to lithium levels?

A

Decreases lithium levels in the blood

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17
Q

What six things should patients avoid when taking Lithium?

A

Alcohol, caffeine, diuretics, SSRI, NSAIDS, ace inhibitors

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18
Q

What medications increase Lithium levels?

A

Diuretics, SSRI, NSAIDS, ACE inhibitors

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19
Q

What decreases Lithium levels?

A

Caffeine

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20
Q

If Lithium causes nausea, what should you advise the patient to do?

A

Take with food

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21
Q

What medication is often used with Lithium?

A

Antipsychotics

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22
Q

How many days can Lithium take to reach its therapeutic level?

A

7 - 21 days

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23
Q

What are initial/transient symptoms of Lithium?

A

Dry mouth, metallic taste, nausea, mild sleepiness, dizziness, mental dulling

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24
Q

What are the symptoms of Lithium?

A

Polydipsis, polyuria, weight gain, mild hand tremor.

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25
Q

How much weight gain is normal for being on Lithium?

A

5 - 10 lbs up to 50

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26
Q

What are patient teachings for lithium toxicity?

A

Blurred vision, diarrhea, muscle weakness, drowsiness, feeling shaky, lack of coordination,

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27
Q

What symptoms can lithium toxicity lead to?

A

Seizures, coma, death, cardiovascular collapse

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28
Q

How often does a patient need to check their lithium blood levels when initially starting treatment?

A

Weekly

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29
Q

How soon can blood be drawn after the last dose of lithium?

A

8-12 hrs

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30
Q

How does lithium effect your thyroid?

A

Can cause HYPO thyroidism. Need to order a ths test.

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31
Q

What doe lithium do to kidney function?

A

It can impair renal function. Order creatinine test or BUN

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32
Q

What are atypical antipsychotics that are used to treat mania?

A

O Lana’Paine (zy’prexa)

Ris per’ Idone (ris’perdal)

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33
Q

Whit is used to reduce mania before lithium is at the therapeutic level?

A

Antipsychotics

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34
Q

Once lithium begins to work, what is often discontinued?

A

Antipsychotics

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35
Q

Why are antipsychotics used to treat mania?

A

Because they are better tolerated than lithium, they reduce mania quicker, and prevent relapse

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36
Q

What can anticonvulsant drugs cause when using to treat mania?

A

Suicidal thinking

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37
Q

What are three anticonvulsant drugs used for treatment of mania?

A

Valproate (depakote)
Carbamazepine (tegretol)
Lamotrigin (lamictal)

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38
Q

What is important to each for when treating with lamotrigine?

A

Life threatening TENS rash?

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39
Q

What is toxic epidermal nec’rolysis?

A

Lamicital TENS rash

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40
Q

How is TENS rash treated?

A

IV immunoglobulin for 5 days

41
Q 
A patient who has been taking lithium carbonate 300mg tid comes to the office with a list of meds he is taking. Which med would require re-evaluation of lithium dosage and why?
A. Respirdal 
B. Ativan 
C. Amoxicillin 
D. HydroDiuril
A

D. HydroDiuril because it is a diuretic

42
Q

What antianxiety meds are used for bipolar?

A

Colnazepam (klonopin)

Lorazepam (Ativan)

43
Q

When are antianxiety meds used for acute mania?

A

Used if patient is resistant to other treatments

44
Q

What do antianxiety meds do for patients with acute mania?

A

Manages psychomotor agitation and aids in sleep

45
Q

Which anticonvulsant medication medication might be prescribed for a patient with bipolar disorder?
A. Divalproex sodium or valproate (depakote)
B. Clonazepam (klonopin)
C. Olanzapine (Zyprexa)
D. Lithium (lithobid)

A

A. Divalproex sodium or valproate (depakote)

46
Q

What % does genetics play in bipolar inheritance?

A

80% - 90%

47
Q

The occurrence rate of bipolar is how much higher if a parent or sibling has BMD?

A

5-10 times higher

48
Q

What disorder is a cyclic illness?

A

Bipolar disorder

49
Q

What does polygenic mean?

A

That multiple genes are involved.

50
Q

True or false BMD is a polygenic disorder?

A

True

51
Q

What happens to dopamine and serotonin levels in people with BMD?

A

Decrease

52
Q

What causes insomnia in BMD patients?

A

Polygenic disease = multiple genes involved including abnormal circadian levels leading to super fast biological clock leading to insomnia for days.

53
Q

What is the elevated form of BMD?

A

Mania

54
Q

What are the two different episodes of behavior in a BMD patient?

A

Elevated (mania) and depressive

55
Q

What is the suicide attempt rate in BMD patients?

A

25- 60%

56
Q

What is the % of death from suicide in the bipolar population?

A

10-20%

57
Q

When is the suicide risk greater in the BMD patient?

A

When they are emerging from a depression or during mixed episodes.

58
Q

What substances can cause or appear to be mania?

A

Amphetamine
Cannabis
Steroids
Antidepressants (especially Ssri may flip person into mania)

59
Q

What other medical conditions can appear to be mania?

A

Schizophrenia
Schizoaffective depression
Hyperthyroid

60
Q

Hypothyroidism can mimic what for of BMD?

A

Depression

61
Q

Hyperthyroidism can mimic what form of BMD?

A

Mania

62
Q

Define bipolar 1.

A

Classic bipolar, mania.

63
Q

Define bipolar 2.

A

Severe depression and hypomanic episodes.

64
Q

Is depression or hypomania required for a diagnosis of bipolar 1?

A

No

65
Q

Is mania required for a diagnosis of bipolar 2?

A

No

66
Q

Define cyclothymic.

A

Mild hypo mania and mild depression, not MDD

67
Q

What is the assessment tool DIG FAST used for?

A

To assess for a bipolar manic Episode

68
Q

Define D in DIG FAST

A

Distractibility

69
Q

Define I in DIG FAST

A

Indiscretion, Impatience, and Irritability

70
Q

Define G in DIG FAST

A

Grandiosity

71
Q

Define F in DIG FAST

A

Flight of ideas and energy

72
Q

Define A in DIG FAST

A

Activity increase

73
Q

Define S in DIG FAST

A

Sleep deficit

74
Q

Define T in DIG FAST

A

Talkative - excessively

75
Q

To be diagnosed with Bipolar 2 the patient has to have a major depressive episode and a hypomanic episode. Name the 7 things that count as hypomanic symptoms.

A
  • Weight loss or gain of more than 5% body weight in one month
  • insomnia or hypersomnia
  • psychomotor agitation or retardation
  • fatigue or loss of energy
  • feelings of worthlessness or inappropriate guilt
  • diminished ability to think concentrate or make decisions
  • recurrent thoughts or suicide or death
76
Q

Define Rapid cycling in BMD.

A

4 or more mood cycles in a 12 month period, they can occur in a day, month or year

77
Q

When is rapid cycling often diagnosed

A

Earlier, teens

78
Q

Is rapid cycling a less or more sever illness than Bipolar 1 and 2?

A

More serious illness and often has more sever symptoms

79
Q

What drugs are used to treat Rapid cycling?

A

Valproate (depakote)
Carbamazepine (tegratol)
lamotrigene (limictal) (watch for TENS rash)

80
Q

Define mixed features as related to bipolar 1 and 2.

A

Both manic and depressive symptoms at the same time but not cyclic.

81
Q

How to you treat Mixed features?

A

Anticonvulsants or antipsychotics

82
Q

When is ECT used for Bipolar disorder?

A

For patients who’s medication does not work or for patients that have severe depressive episodes or highly suicidal or catatonic episodes.

83
Q

Define Anosognosia

A

without knowledge of the disease, patients experiencing mania do not always have the insight to recognize that they suffer from a mental illness, it is not denial!

84
Q

How do you treat the Acute phase of Bipolar disorders?

A

Hospitalize and provent injury

85
Q

How do you treat the continuation phase of Bipolar disorders?

A

Community, psychoeducational groups in community for patient and family to focus on relapse prevention.

86
Q

How do you treat the maintenance phase of Bipolar disorder?

A

Ongoing support, limit severity and duration of future episodes

87
Q

What are the three areas to monitor for in the nursing assessment of patients with bipolar disorder?

A

Safety of the patient and others, suicidal risk (coming out of depress or mixed episodes increase risk), medication adherence and response to ordered medication.

88
Q

What history is important to obtain in the nursing assessment of the Bipolar patient?

A

Medication history and adherent to medications, Past and present sleep patterns and nutritional intake, alcohol and drug abuse history, underlying medical conditions.

89
Q

What four assessment areas are important in the Bipolar patient?

A

Mood, Behavior, Cognitive functioning, Thought processes and speech patterns.

90
Q

What are five characteristics of thought processes and speech patterns in the bipolar patient with mania?

A

Pressured speech, flight ideas, circumstantial, clang associations, grandiosity.

91
Q

Define Pressured speech of the manic patient

A

hasty, emphatic, speech, often too loud

92
Q

Define flight of ideas of the manic patient

A

constant flow of fast speech abrupt changes of topic

93
Q

Define Circumstantial thought processes and speech patterns in the manic patient.

A

Includes much indirectness with lots of details and may never get to the point

94
Q

Define clang associations in the manic patient.

A

Meaningless rhyming of words often with force

95
Q

Define grandiosity in the manic patient.

A

inflated self-regard of ideas “I can do anything”

96
Q

What are four things to remember with communicating with the client in an acute manic phase.

A

Firm and calm approach, use short concise statements, state that behavior that is expected of the patient, remain neutral and avoid power struggles.

97
Q

What is important in discharge planning of the Bipolar patient?

A

Assess patient to identify triggers for becoming depressed or manic, and to identify the warning signs of a serious mood change.

98
Q

What is the purpose of interpersonal and social rhythm therapy?

A

To reduce relapse of bipolar disorder.

99
Q

What does interpersonal and social rhythm therapy involve?

A

Regular schedule of daily activities (sleeping), healthy relationships.

Psych Final (4 decks)

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