Bipolar Meds

Mood stabilizers med to know

Lithium

Lithium complications

GI distress, fine hand tremors, polyuria + mild thirst (spironolactone + adequate fluid intake), weight gain, renal toxicity (baseline BUN and creatinine + monitor kidney function periodically), goiter, hypothyroidism (baseline T3, T4, and TSH levels + levothyroxine), bradydysrhythmias, hypotension, electrolyte imbalances (hyponatremia)

Lithium toxicity common adverse effects

Lithium level: Less than 1.5 mEq/L

Manifestations: Diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, fine hand tremors, slurred speech, lethargy

Nursing Actions: Instruct the client that manifestations at low levels often improve over time.

Lithium toxicity early indications

Lithium level: 1.5 to 2.0 mEq/L

Manifestations: Mental confusion, sedation, poor coordination, coarse tremors, and ongoing GI distress, including nausea, vomiting, and diarrhea

Nursing actions: Instruct the client to withhold the medication, and notify the provider. Administer new dosage based on blood lithium and sodium levels. Excretion can need to be promoted.

lithium toxicity advanced indications

Lithium level: 2.0 to 2.5 mEq/L

Manifestations: Extreme polyuria of dilute urine, tinnitus, giddiness, jerking movements, blurred vision, ataxia, seizures, severe hypotension and stupor leading to coma, and possible death from respiratory complications

Nursing actions: Administer an emetic to alert clients, or administer gastric lavage. Urea, mannitol, or aminophylline may be prescribed to increase the rate of excretion.

lithium toxicity: severe toxicity

Lithium level: Greater than 2.5 mEq/L

Manifestations: Rapid progression of manifestations leading to coma and death

Nursing actions: Hemodialysis can be warranted.

Lithium contraindications

Pregnancy Risk D, discourage breastfeeding.

renal disease, cardiac disease, hypovolemia, schizophrenia.

Use cautiously in older adult clients and clients who have thyroid disease, seizure disorder, or diabetes.

Lithium interactions

Diuretics (decreased blood sodium, lithium excretion decreased) and NSAIDs (concurrent use increases renal reabsorption of lithium) can lead to toxicity; anticholinergics can cause abdominal discomfort due to urinary retention and polyuria

Mood-stabilizing antiepileptic medications to know

Carbamazepine, Valproate, Lamotrigine

Carbamazepine complications

- CNS effects (nystagmus, double vision, vertigo, staggering gait, headache)

- blood dyscrasias (leukopenia, anemia, thrombocytopenia)

- teratogenesis

- hypo-osmolarity (promotes secretion of ADH, inhibiting water excretion and placing client in HF at risk for fluid overload)

- skin disorders (dermatitis, rash [SJS])

Lamotrigine complications

-double or blurred vision, dizziness, headache, nausea, vomiting

-serious skin rashes (SJS)

valproate complications

GI effects (nausea, vomiting, indigestion), hepatotoxicity (assess baseline liver function and monitor regularly), pancreatitis (monitor amylase levels), thrombocytopenia (monitor platelet counts), teratogenesis, weight gain

Carbamazepine interactions

-oral contraceptives, warfarin (decreased effects)

-grapefruit juice (increases blood levels of carbamazepine)

-concurrent use of other anticonvulsants decreases effects of carbamazepine

Lamotrigine interactions

-carbamazepine, phenytoin, phenobarbital (decreases effects of lamotrigine)

-valproate (increases half-life of lamotrigine)

-oral contraceptives (decreases effectiveness of both meds)

Difference between 1st and 2nd gen antipsychotics

-1st gen/typical: EPS common, more neurological s/e

-2nd gen/non-typical: less s/e and less EPS

EPS reversal meds

Benztropine (Cogentin), Diphenhydramine (Benadryl)

1st gen meds to know

Chlorpromazine (Thorazine), Haloperidol (Haldol)

2nd gen meds to know

Clozapine (Clozaril), Risperidone (Risperdal), Ziprasidone (Geodon)

1st gen EPS symptoms

Tardive dyskinesia, akathisia, Pseudoparkinsonism, dystonia

2nd gen Clozapine Nursing Actions

May cause agranulocytosis - monitor WBC count & note any flu-like symptoms