Drugs and Bipolar D/O

Depakote, Lithium, benzodiazepines, bipolar D/O

Bipolar Type 1

• has cyles of depression and mania

• more severe than type 2

Mania: disordered with an elevated or irritable mood lasting at least 1 week (or any duration if hospitalization is necessary).

• may experience psychosis, delusions, or hallucinations

• manic symptoms can be dangerous and life-threatening

• often hospitalized during manic episode due to increase likelihood of risk behaviours that lead to injury or illegal acts and become hospitalized after being arrested

Bipolar Type 2

• don’t experience mania, instead experiences hypomanic episodes

  • hypomania: not as extreme as mania

    • may feel abnormally energetic, happy, or excited

    • no symptoms of psychosis, delusions or hallucinations

    • may make hasty decisions but not to the extend that people have with manic episode

    • doesn’t stand out as much as mania

• some people may experience more chronic or debilitating episodes of depression than people with bipolar I

Bipolar rapid cycling

when manic episodes reoccur > 4 times/year

Lithium [lithium carbonate]

• gold standard for bipolar, only drug that is studied that prevents suicide for bipolar pts

MOA: unknown, modulation of G protein

• acute and maintenance prevents suicide in mood d/o clients

Lithium side effects and toxicity management

S/E

• N/VD

• Blurred vision, tinnitus, dizziness, lethargy impaired motor coordination ataxia, memory problems

• hyperreflexia → tremors in fine motor activities such as writing, painting, myoclonic jerking

• can cause nephrogenic diabetes insipidus → inability to concentrate urine

• diabetes inspididus → inc thirst, inc appetite, weight gain

• Cardiac toxicity → suppresses sinus node → bradycardia and synoscope → monitor EKG

• hypothyroidism → lithium is goitrogen (siuupresses thyroid hormon release) → treat w/ levothyroxine instead of dicontinuing lithium

• teratogenic → passes through placenta and can result in Ebstein’s anomaly (atrioventricular lower/ displacement of the tricuspid vale_

  • this can be surgicall repaired before baby is born while mother is pregnant SO LET PROVIDER KNOW IF YOU ARE PREGNANT

no direct antidote for lithium toxicity, usually hemodialysis

Lithium therapeutic window

0.6 to 1.2 mEq/L

What drugs can increase lithium levels?

ACEI, ARBS, NSAIDS, tetracycline, flagyl

What can decrease lithium level?

potassium-sparing diuretics, thiazide diuretics, and theophylline

What kind of drugs can interact w/ lithium?

can interact w/ some HTN, ABX (antibiotics), and seizure medications (so avoid if possible)

Lithium pt teaching

Tell pt to notify provider/nurse if they experience…. These may be early signs of lithium toxicity

• N/VD

• blurred vision

• muscle weakness

• fine hand tremors

• slurred speech

• caffeine may decrease lithium level

• sodium may change elimination of drug,

• discourage use of St. Wort → may inc risk of serotonin syndrome

• monitor if pt is pregnant

• can take drug w/ water and food to minimize GI upset

• express importance of regular blood tests

• withhold one dose and immediately call prescriber if s/s of toxicity appear, do not stop drug immediately

Depakote/valproic acid