Drugs for Bipolar Disorder EAQ
A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used to do what in the treatment of severe manic episodes? A. Elevate mood during the severe manic episode B. Help control symptoms during the severe manic episode C. Produce sedating effects during the severe manic episode D. Reduce the amount of physical pain the patient experiences during the severe manic episode
B. Help control symptoms during the severe manic episode Antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. Benzodiazepines are given for their sedating effects. Antidepressants help elevate mood during manic episodes.
The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? A. Sodium level of 128 mEq/L B. Prothrombin time of 8 seconds C. Potassium level of 5.6 mEq/L D. Blood urea nitrogen level of 25 mg/dL
A. Sodium level of 128 mEq/L The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation that can result in symptoms of toxicity and even death.
The healthcare provider ordered lamotrigine [Lamictal] for long-term maintenance therapy of bipolar disorder (BPD). The nurse anticipates which dosing schedule? A. Starting at a low dose and titrating up B. Starting at a high dose and titrating down C. Starting at a high dose to quickly control mania D. Starting with a loading dose and then a low maintenance dose
A. Starting at a low dose and titrating up Lamotrigine [Lamictal] is indicated for long-term maintenance therapy of BPD. The goal is to prevent affective relapses into mania or depression. To minimize the risk of a serious rash, dosage should be low initially (25 to 50 mg/day) and then gradually increased.
A nurse assesses a patient who takes a maintenance dose of lithium carbonate [Lithobid] for bipolar disorder. The patient complains of hand tremors, nausea, vomiting, and diarrhea. The patient's gait is unsteady. What is the most likely explanation for these symptoms? A. The patient developed lithium toxicity. B. The patient developed tolerance to the lithium. C. The patient did not take the lithium as directed. D. The patient consumed some foods high in tyramine.
A. The patient developed lithium toxicity Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.
Which statements about the treatment of bipolar disorder does the nurse identify as true? Select all that apply. A. A lithium level of 2.0 mEq/L is considered therapeutic. B. Antipsychotics are used to treat depressive episodes. C. Mood stabilizers are used to prevent recurrent manic-depressive episodes. D. Lithium and valproate are the preferred mood stabilizers for BPD. E. Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression (BPD).
C, D, E The statements in options C, D, and E are true. Antipsychotics are used to treat manic episodes. A lithium level above 1.5 mEq/L is considered to be above the therapeutic index.
The nurse is caring for a patient who is prescribed lithium citrate [Eskalith] and who complains about nausea and gastric upset. What is the best course of action? A. Assess the patient's stool for occult blood. B. Call the healthcare provider to stop therapy. C. Instruct the patient to take the medication with food or milk. D. Assess the patient for other symptoms of gastric ulceration.
C. Instruct the patient to take the medication with food or milk Lithium citrate quite commonly causes gastric upset. Instruct patients to take the medication with food or milk to decrease this risk. There is no reason to stop therapy or assess for ulcers and bleeding unless this intervention does not relieve distress. If the patient continues to complain of pain, further action can be taken.
The nurse is assessing a patient who has been undergoing treatment for bipolar disorder for the past year. The nurse finds that the patient's sodium level is 110 mEq/L and the glucose level is 70 mg/dL. The patient also exhibits signs of neurotoxicity. What should the nurse expect as the reason for these signs? A. The patient is taking vilazodone [Viibryd]. B. The patient is taking paroxetine HCl [Paxil]. C. The patient is taking mirtazapine [Remeron]. D. The patient is taking lithium citrate [Eskalith].
D. The patient is taking lithium citrate [Eskalith]. Lithium citrate [Eskalith] is used in the treatment of bipolar disorder. Long-term administration of lithium citrate may lead to adverse effects such as hyponatremia as it depletes the sodium levels. Hyponatremia is a condition in which sodium levels are decreased in the blood resulting in an electrolyte imbalance. Lithium citrate [Eskalith] can also cause hypoglycemia as it decreases insulin production, and can also cause signs of neurotoxicity because of its effect on the cerebellum. The administration of vilazodone [Viibryd] may result in drowsiness, insomnia, and diarrhea; paroxetine HCl [Paxil] may result in decreased sexual arousal; and mirtazapine [Remeron] may result in an increase in the levels of both norepinephrine and serotonin neurotransmitters in a patient.
The nurse is caring for a patient who has bipolar disorder and has been administered lithium citrate [Eskalith]. The primary healthcare provider asks the nurse to constantly monitor the patient's blood sodium levels. What is the reason for giving such an instruction? A. To ensure proper nourishment in the patient B. To prevent renal toxicity caused by the drug C. To maintain normal cholesterol levels in the body D. To maintain therapeutic concentration of lithium
D. To maintain therapeutic concentration of lithium As both lithium and sodium are monovalent ions, the serum lithium concentration is altered with changes in the sodium concentration. Therefore, in order to maintain a constant therapeutic level, a normal concentration of sodium is required in the body. Sodium levels alone do not ensure that the patient has proper nourishment. Sodium levels do not affect the cholesterol levels in the blood. Regularly monitoring sodium levels will not help in reducing the renal toxicity caused by the medication. The nurse should check the patient's urine output and ensure proper fluid intake to prevent renal toxicity.
The nurse identifies which drug(s) as the principal mood stabilizers used in the treatment of bipolar disorder? Select all that apply. A. Lithium B. Risperidone C. Carbamazepine D. Venlafaxine [Effexor] E. Divalproex sodium [Depakote]
A, C, E Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.
Lithium is used in the treatment of bipolar disorder (BPD) and what other psychiatric disorders? Select all that apply. A. Bulimia B. Alcoholism C. Schizophrenia D. Hypertension E. Glucocorticoid-induced psychosis
A, B, C, E Although approved only for treatment of BPD, lithium has been used with varying degrees of success in other psychiatric disorders including alcoholism, bulimia, schizophrenia, and glucocorticoid-induced psychosis. Nonpsychiatric uses include hyperthyroidism, cluster headache, and migraine. In addition, lithium can raise neutrophil counts in children with chronic neutropenia and in patients receiving anticancer drugs or zidovudine (AZT).
What is essential for the nurse to assess in a female patient taking lithium citrate [Eskalith]? Select all that apply. A. Assess for tremors. B. Monitor sodium levels. C. Assess for urinary retention. D. Determine if the patient is pregnant. E. Assess if the patient is receiving diuretic therapy.
A, B, D, E Lithium citrate [Eskalith] may cause tremors and polyuria. It may be teratogenic, and pregnant patients should not receive this medication. Diuretic therapy can increase lithium levels. Sodium levels should be assessed to decrease the risk of toxicity.
The nurse is seeing several patients in the outpatient clinic. Which patient most requires the nurse's immediate attention? A. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L B. A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction C. A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg D. A female patient with bipolar disorder (BPD) who takes valproic acid [Depakene] and who reports nausea and vomiting
A. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L Lithium levels above 1.5 mEq/L should be reported because this level may indicate impending, serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.
The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? A. Aspirin (ASA) for mild headache B. Ibuprofen [Motrin] for muscle pain C. Hydrochlorothiazide (HCTZ) for edema D. Diphenhydramine [Benadryl] for cold symptoms
A. Aspirin (ASA) for mild headaches Aspirin is safe to use as an analgesic with lithium. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by reducing the serum sodium level. Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.
The nurse is reviewing a patient's medication history and notes that the patient recently began taking lithium [Lithobid]. What intervention is a priority for this patient? A. Assessing lithium levels twice a week B. Monitoring the patient's intake and output C. Asking the patient about ringing in the ears D. Monitoring for the recurrence of seizure activity
A. Assessing lithium levels twice a week Lithium is the drug of choice to treat manic episodes associated with bipolar disorders. It has a narrow therapeutic range, and levels should be monitored twice weekly until the therapeutic level has been obtained and then monitored monthly on the maintenance dose.
The primary healthcare provider prescribes carbamazepine [Tegretol] to a patient who has bipolar disorder. After reviewing the medical history of the patient, the nurse requests that the primary healthcare provider revise the prescription. What is the reason behind this nursing action? A. The patient has kidney dysfunction. B. The patient has bone marrow depression. C. The patient has acute myocardial infarction. D. The patient is hypersensitive to the medication.
B. The patient has bone marrow depression Bone marrow depression is a condition in which the number of hematopoietic cells decreases in bone marrow. Carbamazepine [Tegretol] interferes with the functions of bone marrow, which ultimately results in decreased production of red blood cells, platelets, and white blood cells; therefore, this medication should not be administered to a patient who has bone marrow depression.
The nurse is caring for a patient with acute mania who has been prescribed lithium carbonate [Lithobid]. The blood tests of the patient indicate the serum lithium level to be 1.2 mEq/L. What does the nurse interpret from this? A. The patient will have persistent manic symptoms. B. The patient may have cardiac dysrhythmia and tremors. C. The patient may have impaired liver and renal functioning. D. The patient should have effective relief from the manic symptoms.
D. The patient should have effective relief from the manic symptoms There is a narrow therapeutic window between the therapeutic and toxic serum levels of lithium. A serum lithium level of 1 to 1.4 mEq/L is optimum for the treatment of acute mania. Therefore, a serum lithium level of 1.2 mEq/L indicates that the patient will have effective relief from the manic symptoms. If the serum lithium level is less than 1 mEq/L, then the patient may have persistent manic symptoms. If the lithium serum level is more than 1.5 mEq/L, then the patient may have lithium toxicity, which is characterized by impaired liver and renal functioning. The adverse effects of lithium toxicity include cardiac dysrhythmia and tremors.
