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Flashcards in CH 9 BIPOLAR MEDS Deck (63)
0

Bi polar disorders are primarily managed by what type of drugs?

Bipolar disorders are primarily managed by mood stabilizing meds such as lithium carbonate ( lithane, eskalith, lithotabs)

1

What are other medications used to treat bipolar disorders?

ANTIEPILEPTICMEDICATIONS
medications such as.......
Valproic acid ( depakote)
Carbamazepine ( tegretol, esquetro)
Lamotrigine ( lamictal)

2

What are atypical antipsychotics useful for?

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

3

What can the anxiolytic meds clonazepam( Klonopin) & lorazepam( Ativan) be useful for?

They can be useful in treating acute mania and managing the psychomotor agitation often seen in mania.

4

What are antidepressants good for?

Medications such as bupropion ( Wellbutrin) and sertraline ( Zoloft) can be useful during the depressive phase. These meds are typically prescribed in combination with a mood stabilizer to prevent rebound mania.

5

What is the prototype drug of MOOD STABILIZERS?

Lithium

6

What is the expected pharmacological action of lithium?

Lithium produces neurochemical changes in the brain, including serotonin receptor blockade.m
There is evidence that the use of lithium can show a decrease in neuronal atrophy and / or an increase in neuronal growth.

7

What is the therapeutic use of lithium?

Lithium is used in the treatment of bipolar disorders. Lithium controls episodes of acute mania, helps prevent the return of mania or depression, and decreases the incidence of suicide.

8

What are other uses of lithium?

Alcohol use disorder
Bulimia nervosa
Psychotic disorders

9

What are some side/ adverse effects of lithium?

GI distress ( nausea, diarrhea, abdominal pain)
Fine hand tremors that can interfere with purposeful motor skills and can be exasperated by factors such as stress and caffeine.
Polyuria, mild thirst, wt gain,
Renal toxicity, goiter and hypothyroidism w/ long term tx
Bradydysrhythmia,hypotension and electrolyte imbalances.

10

For a pt. experiencing GI distress from lithium what would be a nursing intervention?

GI distress would be manifested as nausea, diarrhea, & abdominal pain.
Advise clients that effects are usually transient, advise to administer med with meals or milk.

11

What would be a nursing intervention for a pt. experiencing fine hand tremors as a result of lithium?

Administer beta- adrenergic blocking agents such as propranolol (Inderal)
Adjust to lowest possible dosage , give in divided doses, or use long acting formulations.
Advise clients to report a increase in tremors.

12

For a pt. experiencing polyuria, mild thirst as a side effect of lithium, what is a nursing intervention?

Use a potassium sparing diuretic such as spironolactone ( Aldactone)
Instruct clients to maintain adequate fluid intake by consuming at least 2,000 - 3,000 ml. Of fluid from beverages and food sources.

13

For a pt. experiencing renal toxicity as a result of lithium what would be the recommended nursing intervention?

Monitor the clients I&O
adjust dosage and keep dose low
Assess baseline kidney function and monitor periodically

14

What effect can occur with long term tx of lithium?

Goiter and hypothyroidism can occur with long term tx

15

For the diagnosis of goiter and hypothyroidism, what are recommended nursing interventions?

Obtain the clients baseline T3, T4 and TSH levels prior to,starting tx, and then annually.
Advise clients to monitor for manifestations of hypothyroidism such as cold, dry skin, decreased HR, and wt. gain
Administer levothyroxine (Synthroid) to manage hypothyroid effects

16

For a pt. experiencing brady dysrhythmias, hypotension and electrolyte
Imbalances, what is the recommended nursing intervention?

Encourage clients to maintain adequate fluid intake.

17

What are the lab ranges for lithium toxicities?

Less than 1.5 mEq/L.....early indication
1.5 -2.0 mEq/L..............advanced indication
2.0 - 2.5 mEq/L.............severe toxicity
Greater than 2.5 mEq/L.......severe severe toxicity

18

What are the signs and symptoms for a early indication of lithium toxicity with lab values below 1.5.



Diarrhea, nausea, vomiting, thirst polyuria, muscle weakness, fine hand tremor, slurred speech.

19

What are the signs and symptoms of advanced indications of lithium toxicity with lab values from 1.5 -2.0?

Ongoing gastrointestinal distress, including nausea, vomiting, and diarrhea.
Mental confusion, poor coordination coarse tremors.

20

What are signs and symptoms of severe toxicity due to lithium with lab values from 2.0-2.5?

Extreme polyuria of dilute urine, tinnitus, blurred vision, ataxia, seizures, severe hypotension leading to coma and possibly death from respiratory complications.

21

What are signs and symptoms of severe severe lithium toxicity?

Rapid progression of symptoms leading to coma and death

22

What are nursing interventions for a client with early indications of lithium toxicity?

Advise clients to withhold med and notify provider
Administer new dose based on serum lithium levels

23

What are nursing interventions for advanced indications of lithium toxicity?

Advise clients to withhold meds/ notify provider
Administer new dose based on serum lithium levels
If manifestations are severe, it may be necessary to promote excretion.

24

What is the nursing intervention of a client who has severe toxicity of lithium with lab values of 2.0-2.5?

Give alert clients an emetic.
Perform gastric lavage or administer urea, mannitol, or aminophylline to increase the rate of excretion.

25

What is the nursing intervention of a client with severe severe toxicity of lithium with lab values greater than 2.5?

HEMODIALYSIS

26

What are facts about lithium?

Pregnancy category D
lithium is teratogenic, especially during the 1st trimester
Discourage clients from breastfeeding if lithium is necessary
Use cautiously in clients who have renal dysfunction, heart disease, sodium depletion or,dehydration.

27

What are medication/ food interactions of lithium?

Sodium is excreted with the use of diuretics.
Reduced serum sodium decreases lithium excretion, which can lead to toxicity.
Concurrent use of NSAID's will increase renal reabsorption of lithium, leading to toxicity.
Anticholinergics can induce urinary retention and polyuria, leading to abdominal discomfort.

28

Give examples of NSAID's.

ibuprofen....Motrin
celecoxib......Celebrex

29

Give examples of anticholinergics.

Antihistamines
TCA's

30

What are anticholinergics known to do?

Anticholinergics such as antihistamines and TCA's can induce urinary retention and polyuria, leading to abdominal discomfort.

Advise clients to avoid medications with anticholinergic effects.

31

How often should plasma lithium levels be monitored during treatment?

At initiation of treatment, monitor levels Q 2-3 days, then Q 1-3 months.
Older adults often require more frequent monitoring. Lithium blood levels should be obtained in the am, usually 12 hr after the last dose.

32

During initial treatment of a manic episode, what should plasma lithium levels be?

Between 0.8 to 1.4mEq/L

33

What is the Maintenance level range of plasma lithium levels?

Maintenance level range is between 0.4 to 1.0
Plasma lithium levels greater than 1.5 can result in toxicity.

34

How often should lithium be administered?

Lithium must b administered in 2 to 3 doses daily due to a short half life. Taking lithium with food will help decrease GI DISTRESS.
Advise clients that effects begin within 7-14 days.
Lithium has a narrow therapeutic range.
Stress the importance of adequate fluid and sodium intake.

35

When should a client withhold lithium and contact the provider?

If the client is experiencing diarrhea, vomiting or excessive sweating.

36

What are the prototype drugs of AED's.

Carbamazepine (Tegretol, Equetro)
Tegretol & Eqeutro are the same formulation of carbamazepine, and both are effective for the treatment of bipolar disorder. However Equetro is approved for this use.
Valproic acid ( Depakote)
Lamotrigine ( lamictal)

37

What are AED's used for?

AED's help treat and manage bipolar disorders by various mechanisms.

38

What are the expected pharmacological actions of AED's?

1.Slows the entrance of sodium and calcium back into the neuron and thus extending the time it takes for the nerve to return to its active state.
2.Potentiates the inhibitory effects of gamma butyric acid ( GABA)
3. Inhibiting glutamic acid ( glutamate) which In turn suppresses CNS excitation.

39

What are the therapeutic uses of mood stabilizing AED drugs?

Treatment of manic and depressive episodes, prevention of relapse of mania and depressive episodes. Especially useful for clients who have mixed mania and rapid cycling bipolar disorders.

40

What are adverse effects of carbamazepine?

Cognitive function is minimally affected, but CNS effects may include nystagmus, double vision, vertigo, staggering gait, and headache.
Advise clients that CNS effects should subside within a few weeks. Administer dose at bedtime.

41

What are adverse effects of carbamazepine?

Blood dyscrasias ( leukopenia, anemia, thrombocytopenia)

Obtain the clients baseline CBC and platelets & perform ongoing monitoring. Observe client for indications of bruising and bleeding of gums. Monitor for sore throat, fatigue, or other indications of infection.

42

What are adverse effects of carbamazepine?

Teratogeneis

Advise clients to avoid use in pregnancy.

43

What are adverse effects of carbamazepine?

Hypo-osmolarity ( promotes secretion of ADH, which inhibits water secretion by the kidneys and places clients with heart failure at risk for fluid overload.

Monitor serum sodium.
Monitor for edema, decrease in urine output, & hypertension.

44

What are adverse effects of carbamazepine?

Skin disorders ( dermatitis, rash, Stevens-Johnson syndrome)

Treat mild reactions with anti- inflammatory or antihistamine meds.
Advise clients to wear sunscreen.
Instruct clients to notify provider if Stevens- Johnson syndrome rash occurs & to withhold meds.

45

What are adverse effects of Lamotrigine? ( mood stabilizing AED Med)

Common effects include double or blurred vision, dizziness, headache, nausea, and vomiting.

Caution clients about performing activities requiring concentration.

46

What are adverse effects of Lamotrigine?

Serious skin rashes including Stevens-Johnson syndrome.

Instruct client to withhold meds & notify provider if rash occurs.

47

What are adverse effects of valproic acid?

GI effects (nausea, vomiting, indigestion)

Advise clients that manifestations are usually self limiting.
Advise clients to take medications with food or switch to enteric coated pills.

48

What are adverse effects of valproic acid?

Hepatoxicity AEB anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice.

Assess baseline liver function & monitor regularly
Advise clients to observe for indications & notify provider
Avoid use in kids under 2
Administer lowest effective dose.

49

What are adverse effects of valproic acid?

Pancreatitis AEB nausea, vomiting, and abdominal pain

Advise clients to observe for indications & notify provider.
Monitor amylase levels
Discontinue if pancreatitis develops.

50

What are adverse effects of valproic acid?

Thrombocytopenia , Teratogenisis ( avoid use in pregnancy)

Advise clients to observe for manifestations, such as bruising, & to notify provider if these occur.
Monitor platelet counts.

51

What are some contraindications of mood stabilizing AED drugs?

Pregnancy category D and can result in birth defects
Carbamazepine in contraindicated in clients who have bone marrow suppression or bleeding disorders.
Valproic acid is contraindicated in clients who have liver disorders.

52

What are medication/ food interactions of carbamazepine?

Concurrent use of carbamazepine causes a decrease in the effects of oral contraceptives and Coumadin because of stimulation of hepatic drug metabolizing enzymes.

Advise use of alternate form of birth control.
Monitor therapeutic effects of warfarin.
Doses may need to be adjusted.

53

What are food interactions of carbamazepine?

Grapefruit juice inhibits metabolism, thus increasing carbamazepine
Levels.

Advise clients to avoid using grapefruit juice.

54

What are medication interactions of carbamazepine?

Phenytoin and phenobarbital decrease the effects of carbamazepine
By stimulating metabolism.

Monitor phenytoin and phenobarbital levels
Adjust dosage as prescribed.

55

What are medication interactions of Lamotrigine?

Carbamazepine, phenytoin, and phenobarbital promote liver drug metabolizing enzymes thereby decreasing the effect of Lamotrigine

Monitor for therapeutic effects
Adjust dosage as prescribed


56

What are medication interactions of Lamotrigine?

Valproic acid inhibits medication metabolizing enzymes and this increase the half life of Lamotrigine

Monitor for adverse effects
Adjust dosage as prescribed.

57

What are medication interactions of valproic acid?

Concurrent use of valproic acid increases the levels of phenytoin and phenobarbital.

Monitor phenytoin and phenobarbital levels
Adjust dosage as prescribed.

58

A nurse is reviewing the laboratory findings & notes that a clients plasma lithium levels are 2.1. What is an appropriate action of the nurse

Perform immediate gastric lavage, as this will lower the clients lithium level.

59

A nurse is caring for a client who has a new prescription for lithium carbonate ( lithobid). When teaching this client about ways to prevent lithium toxicity, the nurse should advise the client to do what?

Limit aerobic activity in hot weather.
Limit activity that has the potential to cause sodium/ water depletion, which can increase the risk of toxicity.

60

A nurse in a primary care clinic is assessing a client who takes lithium carbonate (lithotabs) for the treatment of bipolar disorder. The nurse should recognize what findings as a possible indication of toxicity to this med?

Severe hypotension, coarse tremors, diarrhea, polyuria are signs of toxicity.

61

A nurse is caring for a client who has anew prescription for valproic acid ( Depakote). The nurse should instruct the client that whole taking this med he will need to have what laboratory tests completed periodically?

Thrombocyte count for ......thrombocytopenia
Amylase for........pancreatitis
Liver function tests for .........hepatoxicity

62

A nurse is teaching a female client who has bipolar disorder about her new prescription for lithium carbonate (lithobid). What is appropriate for the nurse to include in her teaching?

Take with a glass of milk or food
Pregnancy category D, avoid pregnancy while,taking
Lithium can cause goiter and hypothyroidism, the clients thyroid function is assessed prior to giving med.