Term
What are levels for lithium??
Therapeutic
Maintenance
Toxic |
|
Definition
Therapeutic: 0.8 to 1.4 mEg/L
Maintenance: 0.4 to 1.3 mEg/L
Toxic: 1.5 to 2.0 mEg/L |
|
|
Term
| What is lithium main use? |
|
Definition
| Mood stabilizer for bipolar. |
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|
Term
What are the following medications used for?
carbamazepine (Tegretol)
divalproex (Depakote)
lamotrigine (Lamictal) |
|
Definition
| anticonvulsant or antiepiliptic drugs |
|
|
Term
| Which med is used for rapid cycling patients and better tolerated than lithium? |
|
Definition
|
|
Term
| What are concerns with taking Depakote? |
|
Definition
|
|
Term
| What are the side effects of hepatotoxicity? |
|
Definition
| fever, chills, RUQ pain, dark urine, malaise, jaundice |
|
|
Term
| What are the concerns with Lamotrigine (Lamictal)? |
|
Definition
life threatening Rash: Stevens-Johnson syndrome
SE: dizziness, diplopia, HA, ataxia |
|
|
Term
| What are the serious SE of Tegretol? |
|
Definition
| agranulocytosis and aplastic anemia |
|
|
Term
| What is a first line drug for bipolar? |
|
Definition
|
|
Term
| What is the best use for Tegretol? |
|
Definition
|
|
Term
| What are a couple benzodiazepines used along with treatment resistant manic patients? |
|
Definition
clonazepam (Klonapin)
lorazepam (Ativan) |
|
|
Term
| What are 3 reasons to use ECT on manic patient? |
|
Definition
1. unable to wait until drug takes effect.
2. can't tolerate first-line drug
3. does not respond to first-ling drug |
|
|
Term
| What manic patients are especially helped with ECT? |
|
Definition
1. rapid cycling (4 ore more/year)
2. paranoid-destructive features that respond poorly to lithium
3. severe and manic patients
4. highly agitate states
5. pregnant female |
|
|
Term
| What are outcomes of psychoterapeutic treatments? |
|
Definition
1. bipolar disease is chronic, recurrent disease
2. many pts do not fully recover between episodes
3. 30-60% do not regain full occupational and social functioning
4. adjuvan treatments necessary along with meds |
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|
Term
| What are 3 therapies used for medication-stabilized bipolar patients |
|
Definition
cognitive
behavioral
psychoeducation |
|
|
Term
| What is the definition of bipolar disorders? |
|
Definition
mood disorders that include 1 or more episodes of mania or hypomania (elevated, expansive, or irritable mood)
AND
1 or more depressive episode |
|
|
Term
| What is efficacy of bipolar disorder? |
|
Definition
neurobiological:
biochemical imbalance in brain and thought to be genetically transferred
Medication adherance is key to nursing and counseling interventions |
|
|
Term
| when should a bipolar patient be hospitalized? |
|
Definition
acute or sever manic phase
hypomania rarely needs hospitalization unless there is a danger to self or others |
|
|
Term
| What are the 3 categories of disorders of bipolar disorder? |
|
Definition
1. cyclothymia
2. bipolar disorder (I and II)
3. bipolar disorder not otherwise specified
Symptoms of I and II more serious than cyclothymia |
|
|
Term
|
Definition
- chronic mood disturbance of at least 2 years
- with recurrent experience of some symptoms of hypomania
- alternating with dysthymic depression |
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|
Term
| Do people with cyclothymia have severe impairment in social or occupational function? |
|
Definition
No.
Also, they DO NOT experience psychotic symptoms such as delutions. |
|
|
Term
| Distinguish between Bipolar I and Bipolar II |
|
Definition
I: 1 or more episode of MAJOR DEPRESSION + 1 or more periods of CLEAR CUT MANIA
II: 1 or more periods of MAJOR DEPRESSION + at least one HYPOMANIC EPISODE |
|
|
Term
| Describe the onset of Bipolar I manic episode. |
|
Definition
-begins suddently
- last a few days to months
- impairment in reality testing
- can be gradiose or persecutory DELUSIONS
- social, occupational, interpersonal impairment
- hospitalization often required (protects pt from poor judgment and hyperactivity) |
|
|
Term
| What are 2 difference in hypomania that are not criteria for mania? |
|
Definition
- delusions are never present
- hospitalization is not indicated |
|
|
Term
| What are the 3 phases of bipolar disorder and which phase requires hospitalization? |
|
Definition
1. acute phase (requires hospitalization)
2. continuation phase: lasts 4-9 months
3. maintenance treatment phase: aimed at preventing recurrence of an episode |
|
|
Term
| What are assessment signs of acute phase (manic)? |
|
Definition
- hyperactivity (pacing, restlessness, accelerated actions)
- overconfident
- little sleep
- poor social judgment
- reckless spending
- speech loud, rhyming, rapid
- brief attention span, flight of ideas, DELUSIONS
- paranoid
- impatient, uncooperative, abusive, manipulative |
|
|
Term
| What is the primary consideration for hospitalization during manic episode? |
|
Definition
prevention of exhaustion and death from cardiac collapse
RISK FOR INJURY |
|
|
Term
| What is a nursing dx for aggression during mania? |
|
Definition
| Risk for violence: self-directed or other-directed |
|
|
Term
| What is nursing dx for grandiosity and poor judgment during mania? |
|
Definition
Distrubed thought process (due to grandiose thinking and poor judgment)
Ineffective coping (faulty thinking)
includes:
- giving away money and possessions
- neglect of family
- foolish business deals or life changes |
|
|
Term
| What are some nursing interventions with pt during manic episode? |
|
Definition
- firm, calm approach
- short statements
- neutral, avoid power struggles
- consistent, structured environment
- redirect energy (exercise but not competitive)
- decrease env. stimuli
- solitary activities
- frequent rest periods
- high calorie drinks and finger foods |
|
|
Term
| What are the 3 interventions for at risk manic patient? |
|
Definition
1. firmly setting limits
2. chemical retraints (transquilers)
3. seclusion |
|
|
Term
| What 2 actions do mood stabilizers contain to treat bipolar disorder? |
|
Definition
|
|
Term
| What are 2 medications considered the "first-line treatment" for manic-depressive episodes? |
|
Definition
Lithium (acute mania)
Depakote (anticonvulsant)
Other anticonvulsants used:
Tegretol
Lamictal |
|
|
Term
| How long does it take lithium to reach therapeutic levels? |
|
Definition
|
|
Term
| What pts are contraindicated to use LITHIUM? |
|
Definition
- pregnancy
- brain damage
- cardiovascular disease
- renal or thyroid disease |
|
|
Term
| What pt may not respond to lithium? |
|
Definition
rapid cyclers: 4 or more cyles per year
Bipolar II
Dysphoric mania |
|
|
Term
| What are expected SE of lithium? |
|
Definition
fine hand tremors
polyuria
mild thirst |
|
|
Term
| What are SE of lithium during therapeutic levels (0.8-1.4) |
|
Definition
- mild nausea
- general discomfort
- weight gain (helped with diet/exercise) |
|
|
Term
| What are the early signs of toxicity for lithium? |
|
Definition
-N/V
- diarrhea,
- polydipsia
- polyuria
- slurred speech
- muscle weakness |
|
|
Term
| What are symptoms of severe toxicity to lithium levels? (1.5 to 2.0) |
|
Definition
- ataxia
- blurred vision
- large output of dilute urine
- seizures
- stupor
- severe hypotension
- pulmonary complications
- DEATH |
|
|
Term
| What benzodiazepine has also been used with success with acute mania? |
|
Definition
|
|
Term
| What is the MA of lithium? |
|
Definition
increase in NE reuptake and increase in serotonin receptors
produce antimanic and antidepressant effects |
|
|
Term
| What is the typical maintenance dose of lithium? |
|
Definition
|
|
Term
| Lithium is secreted in the kidneys so what level must be maintained? |
|
Definition
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