Bipolar Drugs Assessment 2

Nursing interventions

1)Monitor plasma lithium levels: every 2-3 days at initiation, then every 1 to 3 months; lithium blood levels drawn in am, usually 12 hours after last dose. 2)Administered in 2 to 3 doses daily due to short half life; dose based on drug levels 3)Encourage patient to maintain adequate fluid intake Teach patient how to monitor for signs and symptoms of toxicity

Bipolar

Serious psychiatric disorder characterized by extreme mood swings from depression to euphoria. Mania may involve an excess of glutamate or NE or a deficiency of inhibitory neurotransmitters such as GABA. For patients with severe symptoms, they require a combination therapy including a mood stabalizer + atypical antipsychotic.

The nurse is reviewing the laboratory report with the client's lithium level prior to administrating the 1700 hours dose. The lithium level is 1.8mEq/L. The nurse should: A. administer the 1700 hours dose of lithium B. hold the 1700 hours dose of lithium C. give the client 240 mL of water with the lithium D. give the lithium after the client's supper

The nurse should hold the 1700 hours dose of lithium because a level of 1.8 mEq can cause adverse reactions. the nurse should report this lithium level to the health care provider and monitor the patient for signs of lithium toxicity

Periodic assessment of which two system functions should be followed?

Thyroid and renal function (because lithium can cause hypothyroidism and impairment of the kidney's ability to concentrate urine).

The plan of care for a patient who takes lithium (Lithobid) should include: 1. dietary teaching to restrict daily sodium intake 2. periodic laboratory monitoring of renal and thyroid function 3. the requirement for laboratory tests to monitor serum potassium level 4. the importance of discontinuing the medication if fine hand tremor occurs

(periodic laboratory monitoring of renal and thyroid function Two major long-term risks of lithium therapy are hypothyroidism and impairment of the kidney's ability to concentrate urine; therefore, a person receiving lithium therapy must have periodic follow-ups to assess thyroid and renal function. Weight gain and fine tremors are common side effects associated with this medication, but the patient should continue taking the medication. Sodium intake for clients who take lithium is not restricted.)

Mood Stabilizer Lithium Carbonate (Eskalith, Lithobid)

-Used for pt. with classic euphoria mania -Lithium is an inorganic element that is found in the same group as sodium and potassium. -Lithium controls acute manic episodes and helps in preventing the recurrence of mania & depression. -Lithium decreases euphoria, hyperactivity without causing sedation. -Reduces suicidal risk more than valproic acid -Because of SE, valproic acid is now the drug of choice for initial treatment of mania MAO is unknown, but likely increases serotonin in specific brain regions -Effects may begin to take effect within 7- 21 days

A manic patient has been taking lithium for 9 months. When the patient's serum laboratory results are complete, the nurse should compare the patient's lithium levels to what therapeutic range? A. 0.2-0.8 mEq/L B. 0.6-1.2 mEq/L C. 1.2-2 mEq/L D. 2.4-3.2 mEq/L

0.6-1.2

What other agents are used to control symptoms of Bipolar disorder?

1) Anti seizure- Valproic acid has a wider therapeutic index but does not prevent suicide. It also is a teratogenic so shouldn't be used with pregnant women. 2) Atypical anti-psychotic agents-Long term mood stabilizer and usually combined with Valproic acid or lithium. Better than conventional anti-psychotic because it has lower incidence of extrapyramidal adverse effects. -aripiprazole (Ablify) -olanzapine (Zyprexa) -quetiapine (Seroquel) -risperidone (Risperdal) -ziprasidone (Geodon) *only olanzapine is approved for long term maintenance therapy 3) SSRI Anti-depressants concurrently with mood stabilizer -venlafaxine (Effexor) -bupropion (Wellbutrin)

Mood Stabilizer Lithium Carbonate (Eskalith, Lithobid) Drug interactions

1) Diuretics increase risk of toxicity by promoting sodium loss 2)NSAIDs increase lithium levels by increasing renal reababsorption of lithium

Mood Stabilizer Lithium Carbonate (Eskalith, Lithobid) SE/AE

1) Muscle weakness 2) Lethargy 3) Poly/Nocturia 4) Headache 5) Dizziness/Drowsiness 6) Tremors *Zombia symptoms

Overdose is treated with...

1)Emesis/Lavage 2)Maintaining airways 3)Dialysis

early signs of toxicity occur

1.5

which of the following findings is a factor in the development of lithium toxicity? A. Hyponatremia B. Hypercalcemia C. Hypocalcaemia D. Hypernatremia

A The client who is taking lithium needs an adequate intake of sodium and fluid to prevent the development of lithium toxicity

Which of the following symptoms is classified as a moderate lithium toxicity: A Confusion and ataxia. B Muscle fasciculations and oliguria. C Tinnitus and blurred vision. D Apathy and Lethargy.

A&C

A 25-year-old female was recently diagnosed with Bipolar disorder. Which of the following statements would indicate to the nurse that the patient needs more education? a. "The doctor is going to prescribe me a low dose of Lithium first, and may increase the dose if he feels it's needed" b. "I will need to have my lithium levels checked periodically to make sure my levels don't get too high." c. "I only have to take Lithium for a few weeks until my symptoms subside" d. "Lithium is going to help treat my manic episodes."

C (Rationale: Similar to an antibiotic, it is a common mistake for people to think that once the symptoms go away the medication does not need to be taken anymore. However, for a full therapeutic effect, medications should be taken for the entire duration that they are prescribed.)

Moderate lithium toxicity (4)

Confusion, ataxia, tinnitus, blurred vision

Which of the following symptoms is classified as a mild lithium toxicity: A Confusion and ataxia. B Muscle fasciculations and oliguria. C Tinnitus and blurred vision. D Apathy and Lethargy.

D Mild toxicity has a lithium serum level of 1.5 mEq/L. Symptoms include apathy, lethargy, coarse hand tremors and slight muscle weakness

Which of the following symptoms is classified as a mild lithium toxicity: A Confusion and ataxia. B Muscle fasciculations and oliguria. C Tinnitus and blurred vision. D . Apathy and Lethargy.

D Mild toxicity has a lithium serum level of 1.5 mEq/L. Symptoms include apathy, lethargy, coarse hand tremors and slight muscle weakness.

Emergency management

Gastric lavage and treatment with urea, mannitol, and aminophyline can hasten lithium excretion.

What is used in extreme cases of lithium toxicity?

Hemodialysis

Lithium Toxicity

Hold the medication Draw lithium levels Treat dehydration Hospitalization at severe toxicity and an emetic is administered

What can dehydration do to lithium levels in your body?

Increase lithium levels

Mood Stabilizer Lithium Carbonate (Eskalith, Lithobid) Long term use

Leads to L = leukocytes I = increased T = tremors, thirst (polydipsia) H = hypothroidism I = increased (polyuria) U = urine M = muscle twitching, motor incoordination

What could a low sodium intake lead to?

Lithium retention which could lead to toxicity

A nurse is giving instructions to a client receiving lithium citrate. The nurse tells the client to do which of the following to prevent lithium toxicity: 1)Avoid becoming dehydrated during exercise. 2)Instruct the client to change positions slowly. 3)Restrict salt intake in the diet. Limit fluid intake. 4)Limit fluid intake

Lithium toxicity usually occurs during chronic treatment because of reduced drug excretion (dehydration, worsening renal function, concurrent infections, and drug interactions

Severe lithium toxicity (2)

Muscle fasciculations and oliguria

Mood Stabilizer Lithium Carbonate (Eskalith, Lithobid) Black box warning

Narrow Therapeutic range/window/index is 0.8 to 1.4 mEq/L *Must monitor blood frequently- so blood drawn to measure serum lithium levels. Low sodium levels may lead to high lithium levels and toxicity Early symptoms: GI upset & confusion Other: drowsiness, lethargy, slurred speech, ataxia, giddiness, blurred vision, tinnitus and large urine output; serious renal impairment

Should you take lithium with or without meals?

With meals

How long does lithium therapy take to reduce acute manic and hypomanic episodes?

Within 7-21 days.

A nurse is giving instructions to a client receiving lithium citrate. The nurse tells the client to do which of the following to prevent lithium toxicity: a)Avoid becoming dehydrated during exercise. b)Instruct the client to change positions slowly. c)Restrict salt intake in the diet. d)Limit fluid intake.

a Lithium toxicity usually occurs during chronic treatment because of reduced drug excretion (dehydration, worsening renal function, concurrent infections, and drug interactions_

Which statement made by pt. who is taking Lithium indicates further teaching is necessary? a)"I will remain on a low sodium diet" b)"I will have blood drawn every 2-3 months" c)Lithium has a narrow margin of safety so toxicity is a real concern" d)"I will not be able to breast feed"

a)"I will remain on a low sodium diet" Patient should be conscious of maintaining normal sodium intake. Because lithium is salt, if sodium intake is low, the body will replace the sodium with lithium leading to lithium toxicity.

A client taking lithium carbonate (Lithobid) started complaining of nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, blurred vision and ringing in the ears. The lithium level is 2 mEq/L. The nurse interprets this value as: A Normal level. B Toxic level. C Below normal level. D Above normal level.

b The therapeutic drug serum level of lithium is 0.6 to 1.2 mEq/L