From ANCC Review
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| show | control symptoms of agitation, aggression and impulsivity. return to usual levels of psychosocial functioning. if depressed, avoid precipitation of manic episode.
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| show | initiate lithium or valproate in combination with an antipsychotic
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| show | may use monotherapy with lithium, valproate or an atypical antipsychotic
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| show | add another first line medication
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| baseline labs for lithium | show 🗑
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| show | assess for hepatic, hematological and bleeding abnormalities and pregnancy
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| Bipolar disorder stabilization and maintenance phase goals | show 🗑
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| show | maintenance medication is recommended following a manic or depressive episode. Monitor lithium or valproic levels, hematologic and hepatic functioning at least every 6 months
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| Valproic acid makes this condition worse | show 🗑
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| show | current approach is to tx acute mania or severe aggressive behavior with atypical antipsychotic or combination with mood stabilizer.
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| show | lithium
but studies show useful for severe aggression
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| show | gain weight compared to adults (lithium, anticonvulsants, atypical antipsychotics)
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| show | they have a more rapid onset of action than lithium and mood stabilizers
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| Lithium is indicated for | show 🗑
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| Lithium is excreted in | show 🗑
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| show | 900-2400mg/day (adult) in divided doses
SR dose 900-1800mg/day
1200-1800mg/day (child) in divided doses
start at 300mg 2-3x/day and adjust
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| show | adolescent or adults 900-1200mg /day
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| lithium has a __ half life and __ therapeutic index | show 🗑
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| show | 7-14 days
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| Maintenance with lithium lasts | show 🗑
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| show | frequent physical exams and labs.
Check twice a week when starting, weekly with dose change
Check dose 3-4 days after dose increases and every 3-6 months after achieving maintenance dose
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| When should blood draws for lithium occur | show 🗑
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| show | 0.6-1.2mEq/L
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| Lithium Blood Levels - Maintenance Episodes | show 🗑
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| Common adverse effects of lithium | show 🗑
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| Signs of lithium toxicity | show 🗑
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| Lithium toxicity is a medical emergency, do the following: | show 🗑
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| lithium affects the kidneys at this time | show 🗑
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| show | avoid dehydration!!!
excessive salt or excessive fluid intake
take with meals to reduce GI upset
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| Excess sodium = Low sodium = | show 🗑
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| show | NSAIDS, thiazide, diuretics, use potassium sparing diuretics, ACE inhibitors, low sodium dehydration, renal disease
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| show | caffeine, theophylline = decreased response
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| These may reduce tremor associated with lithium | show 🗑
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| show | ST segment changes, T wave flattening, arrythmias, conduction disturbances
Done baseline and annually
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| Lithium is in this class | show 🗑
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| Anticonvulsant mood stabilizers have therapeutic effects on reducing mania after | show 🗑
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| show | N/V/D and sedation
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| Common maintained adverse effects of anticonvulsants | show 🗑
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| for weight gain with anticonvulsants | show 🗑
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| show | lamotrigine and topirimate
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| show | consider low dose beta blocker
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| show | monitor PT and platelets
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| show | monitor WBC
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| This anticonvulsant is known for causing issues with WBC | show 🗑
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| valproate/divalproex depakene/depakote is useful for | show 🗑
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| show | 1200-2500mg/day (adult)
up to 20mg/kg/day for child/adolescent
can use loading dose - 2mg/kg in divided doses
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| show | weight gain, alopecia, nausea, diarrhea, tremor, thrombocytopenia, spina bifida- if pregnant, pancreatitis, elevated LFTs, PCOD
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| show | LFTs - monthly and in the first 6 months then q6 months
amylase
HCG
CBC w Diff
PT/PTT baseline and q 6 mo
depakote level 2 weeks after starting then q3-6 mo
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| show | 50-125
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| show | pancreatitis
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| show | liver disease
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| show | ammonia level
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| carbamazepine (Tegretol) dosing | show 🗑
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| show | augmenting agent for acute mania
rapid cycling
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| show | inducer
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| carbamazepine (Tegretol) side effects | show 🗑
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| if at risk for aplastic anemia/agranulocytosis | show 🗑
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| show | stevens johnson's syndrome
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| labs for carbamazepine (Tegretol) | show 🗑
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| Blood levels for tegretol range | show 🗑
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| show | 900-3600mg/day
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| show | gabapentin - well tolerated but questionably effective.
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| show | anti-anxiety, pain control effects, fibromyalgia and anti - craving
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| Side effects of neurontin | show 🗑
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| show | 100-400mg/day
start at 25mg/day
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| lamictal is indicated for | show 🗑
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| show | Steven Johnson Syndrome. Start low and go slow
Children/adolescents have higher risk of rash than adults
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| this increases risk of rash associated with lamictal | show 🗑
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| side effects of lamictal | show 🗑
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| if a pt misses more than 5 days of lamictal, | show 🗑
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| show | 50-300mg/day
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| use for topamax | show 🗑
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| show | weight loss
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| show | short term memory loss, cognitive slowing, paresthesias, nephrolithiasis
DOPAMAX - Cognitive slowing
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| topamax is contraindicated if | show 🗑
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| oxcarbazepine (Trileptal) dosage | show 🗑
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| side effects of oxcarbazepine (Trileptal) | show 🗑
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| oxcarbazepine (Tegretol) interferes with this medication | show 🗑
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| show | Keppra, Gabitril, Zonegran, Equetro
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