NURS 309: MEDS TO TREAT BIPOLAR DISORDER

Haloperidol – Class & Action

A client is prescribed haloperidol for severe agitation. How does this medication work?

Haloperidol – Therapeutic Use

What is haloperidol used for?

Treatment of psychosis, severe agitation, and aggression, including manic episodes in bipolar disorder when other treatments are ineffective.

Haloperidol – Nursing Assessment

Before and during therapy, what should the nurse assess?

Monitor for EPS and neuroleptic malignant syndrome, assess QT interval via ECG, monitor mental status, sedation level, orthostatic hypotension, CBC, and liver function tests.

Haloperidol – Administration

How is haloperidol administered?

Oral (with food or water; do not mix liquid form with coffee/tea) or IM using Z-track technique. After IM injection, keep client supine for 30 minutes to prevent hypotension.

Haloperidol – Common Side Effects

What side effects may occur?

Dry mouth, drowsiness, constipation, urinary retention, orthostatic hypotension, dizziness, headache, weakness, confusion, anorexia, weight gain, and anticholinergic effects.

Haloperidol – Adverse Effects

Which adverse effects require immediate attention?

EPS, neuroleptic malignant syndrome, torsades de pointes, QT prolongation, agranulocytosis, seizures.

Haloperidol – Drug Interactions

Which medications interact with haloperidol?

CNS depressants (opioids, antihistamines, sedatives), anticholinergics, medications that prolong QT interval (antihypertensives, nitrates, quinidine), lithium (risk of encephalopathic syndrome), and other QT-prolonging agents.

Haloperidol – Contraindications

Who should avoid haloperidol?

Clients with hypersensitivity, dementia-related psychosis (boxed warning), Parkinsonism, severe CNS depression, bone marrow suppression, severe hepatic or cardiac disease, closed-angle glaucoma, or those who are pregnant/breastfeeding (use only if necessary).

Haloperidol – Precautions

Which clients require caution?

Clients with cardiac, respiratory, or renal disease; diabetes; seizures; intestinal obstruction; and older adults (especially high EPS risk).

Haloperidol – Client Teaching

What should clients be taught?

Do not stop abruptly; report EPS (tremors, rigidity), fever, palpitations, fainting, dark urine, sore throat, or jaundice; manage dry mouth with fluids or gum; avoid alcohol; increase fluids and fiber for constipation; inform providers of all medications.

It is a conventional (first-generation) antipsychotic that blocks dopamine (D2) receptors in the brain, also affecting alpha-adrenergic, cholinergic, & histamine receptors, reducing psychosis & mania.

Lithium – Class & Action

A client is prescribed lithium for bipolar disorder. How does this medication work?

Lithium – Therapeutic Use

What is lithium used for?

Acute manic and mixed episodes in bipolar disorder, and long-term maintenance therapy to prevent mood swings.

Lithium – Nursing Assessment

Before and during therapy, what should the nurse assess?

Renal function, thyroid function, cardiac rhythm, mental status (mood, orientation, behavior), and suicidal ideation.

Lithium – Administration

How is lithium administered?

Orally with food or milk. Extended-release tablets must not be crushed or chewed.

Lithium – Common Side Effects

What side effects may occur?

Tremor, lethargy, headache, confusion, muscle weakness, dizziness, memory impairment, dry mouth, blurred vision, and GI upset.

Lithium – Adverse Effects

Which adverse effects require immediate attention?

Lithium toxicity (vomiting, diarrhea, slurred speech, ataxia, tremors, drowsiness, twitching), renal failure, hypothyroidism, EPS, serotonin syndrome, and DRESS.

Lithium – Drug Interactions

Which medications interact with lithium?

NSAIDs, diuretics, metronidazole (increase lithium levels/toxicity), SGLT2 inhibitors (reduce effectiveness), and serotonergic medications (increase serotonin syndrome risk).

Lithium – Contraindications

Who should avoid lithium?

Clients with severe renal disease, severe cardiac disease, Brugada syndrome, pregnancy, breastfeeding, or children under 12 years

Lithium – Precautions

Which clients require caution?

Clients with dehydration, sodium imbalance, diabetes, high fever, or those taking diuretics (must maintain hydration and sodium balance).

Lithium – Client Teaching

What should clients be taught?

Maintain consistent salt intake and drink 2–3 L/day of fluid; attend lab monitoring for lithium levels; report toxicity signs immediately (GI upset, tremor, confusion, slurred speech); avoid driving until effects are known; notify provider if pregnant or breastfeeding.

It is a mood stabilizer that alters sodium ion transport in nerve cells & affects neurotransmitter reuptake, stabilizing mood & reducing mania & depression.

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