Bipolar Disorder

• What is Bipolar disorder?

• Emotions become intense and often unpredictability

• Can swing from extreme happiness to extreme sadness

• What is a manic episode?

• Abnormally elevated or irritable moods that last at least a week and impair functioning. But not all become depressed

• What is a manic episode characterized as?

• Elation

• Irritability

• Expansion

• At least 3 of following symptoms

  • Grandiosity

  • Diminished need for sleep

  • Excessive talking or pressure speech

  • Racing thoughts or flight of ideas

  • Clear evidence of distractibility

  • Increased level of goal focused activity at home at work or sexually

  • Excessive pleasurable activities

• What are the types of mania and them regarding safety

• Hypomania

  • Not really danger

  • Hyped up/goal oriented and starting to burn out

• Acute mania

  • Derailment form normal function

  • Danger

• Extreme delirious Mania

  • Much more of a danger

• What is the pathophysiology of bipolar disease?

• Neurotransmitter disease

• Membrane and cation hypothesis

  • Abnormal neuronal and sodium activity and abnormal homeostasis as the cause for neurotransmitter dysregulation

• What is the difference between the pharmacologic treatment for bipolar?

• Short term

  • Acute symptoms

• Long term

• Mood stabilizers

• (regulates the extreme shifts in emotions between mania and depression

• What is the action of lithium carbonate?

• Not well understood

• Behaves lake Na- its ions alter Na ion transport in nerve cells to generate Ap which results in

  • Modulation of dopamine, glutamate and GABA neurotransmission

• Brings swings to “center”

• What is lithium carbonate used for?

• Agent for bipolar disorder

• What are the side effects of lithium carbonate?

• Gi distress

• Fine hand tremors

• Thirst

• Weight gain

• Renal insufficiency

• Bradycardia

• Hypotension 

• Electrolyte imbalance

• What is the early signs of lithium toxicity?

• n/v/d

• Fine tremors

• Thirst

• Polyuria

• Muscle weakness

• Lethargy

• What are the interventions of early lithium toxicity?

• Tell pt to hold med

• Contact dr about lithium levels

• What are the signs of advanced lithium toxicity?

• Increased GI

• Coarse tremors

• Confusion

• Poor coordination

• Sedation

• What are the interventions for advanced lithium toxicity?

• Hold med

• Check lithium levels

• May need to promore excretion

• What are the signs of severe lithium toxicity?

• Extreme polyuria

• Tinnitus

• Ataxia

• Seizures

• Severe hypotension

• Late stage oliguria

• Coma

• Death

• What are the interventions for severe lithium toxicity?

• Check levels

• Emetic

• Gastric lavage

• Hemodialysis

• What are blood levels of early lithium toxicity?

• 1.5 and below

• What are blood levels of advanced lithium toxicity?

• 1.5-2

• What are blood levels of severe lithium toxicity?

• 2.0-2.5 and above

• What are the contraindications of lithium carbonate?

• Pregancy

• Breastfeeding

• Severe cardiac

• Renal disease

• What are the precautions of lithium toxicity?

• Dehydration

• Hyponatremia

• Renal insufficiency

• What are the interactions regarding lithium carbonate?

• Diuretics

  • Na and fluid causes toxicity

• NSAIDS

  • Causes renal retention of lithium

• Anticholinergics

  • Urinary and gastric retention

• What is the nursing assessment for lithium?

• Vital signs

• Fluid balance

• Labs

  • CBC Chem, thyroid panel

• Renal function

• Cardiac status

• Medication profile

• What is the teaching for lithium?

• Take with food

• Make sure go to labs

• HYDRATION

  • 3L a day

  • Lithium become toxic easily is hot weather and during exercise

• What drugs are mood stabilizers?

• Carbamazepine (Tegretol)

• Lamotrigine (Lamictal)

• Valproic acid (Depakene)

• What is the action of Carbamazepine (Tegretol)?

• Inhibits sodium, potassium and calcium channels

• What is the action of Lamotrigine (Lamictal)?

• Inhibits sodium and calcium channels

• What are the side effects of Carbamazepine (Tegretol)?

• Blood dyscrasia

• Heptotoxcity

• Steven johnson

  • Immune response in which patients cells attack its own cells in response to a drug

• What are the side effects of Lamotrigine (Lamictal)

• Skin rash

• Steven johnson

• What is the side effects of Valproic acid (Depakene)

• GI effects

• Pancreatitis

• Heptotoxcity

• Thrombocytopenia