Study Bipolar Disorder Flash Cards

 
Pile Management Card
Bipolar Disorder

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Lithium: Side Effects on 9 Systems
>>Know the different systems it affects<<

1. Gastrointestinal
2. Nervous System [& Neuromuscular]
3. Endocrine
4. Hematological
5. Cardiovascular
6. Dermatological
7. Weight gain
8. Teratogenesis
9. Renal (i.e. Kidney)

(L4-5, P4)
LIthium's Side Effects: Renal
>>Know<<

Renal (i.e. kidney) excretion [need to be careful, because a person with dialysis will maintain more sodium = toxicity].

Sodium loss increases retention of lithium.

Causes of excessive sodium loos: vomiting, diarrhea, dehydration, sweating, diuretics, salt restricted diets, [& fever].

(L4-5, P4)
Lithium's Side Effects: Teratogenesis
>>Know<<

Contraindicated during pregnancy, especially 1st trimester.

[Can't give it to a woman during the 1st trimester of pregnancy, because it'll cause malfunctions.]

(L4-5, P4)
Lithium's Side Effects: Weight Gain
>>Know<<

Up to 20 pounds in at least 20% of patients.

(L4-5, P4)
Lithium's Side Effects: Dermatological
>>Know<<

Rash, acne.

Only stop lithium therapy if severe.

(L4-5, P4)
Lithium's Side Effects: Cardiovascular
>>Know<<

EKG changes

[Lithium has specific influences on EKG peaks, so changes on EKG is very important.]

(L4-5, P4)
Lithium's Side Effects: Hermatological
>>Know<<

Benign increase in white blood cell count.

(L4-5, P4)
Lithium's Side Effects: Endocrine
>>Know<<

Hypothyroidism & goiter.

(L4-5, P4)
Lithium's Side Effects: Nervous System [& Neuromuscular]
>>Know<<

Early headache, lethargy, muscle weakness, fine hand tremor (any time).

(L4-5, P4)
Lithium's Side Effects: Gastrointestinal
>>Know<<

Nausea, vomiting, diarrhea.

Watch toxic levels [because GI symptoms may be critical indicators of lithium toxicity].

(L4-5, P4)
Lithium: Precautions & Onset
>>E.g. What's the therapeutic window? Narrow because it's close to toxicity<<

Narrow "therapeutic window" - therapeutic effect is close to toxicity.

Need to evaluate blood concentration levels to avoid toxicity.

Onset action is from 5-14 days.

[Depends on metabolism, weight, gender, etc. of individual.]

[Need to constantly check the client's blood level & weight.]

(L4-5, P3)
Bipolar I v. Bipolar II
>>Be able to differentiate between I & II<<

Bipolar I - can occur without major depressive episode; 1 or more manic/mixed episode(s); occupational/social impairment; hospitalization needed.

Bipolar II - 1 or more major depressive episodes; 1 or more hypomanic episode(s); never manic/mixed episode; no significant impairment; no hospitalization needed.

(L4-5, P2)
Lamotrigine (Lamictal): Side Effects
(Anticonvulsant)

CNS - dizziness, headache, ataxia, drowsiness, & tremor.

GI - nausea & vomiting.

Dermatological - Steven Johnson Syndrome [i.e. a rash that attacks all the mucus areas in the body (e.g. eye, nose, etc.)].
Well tolerated.
Lamotrigine (Lamictal): Main Uses
(Anticonvulsant)

1st liine for bipolar depression, acute & maintenance.

2nd line for rapid cycling.

[Newest medication; used for bipolar II, maybe for bipolar I also.]

(L4-5, P5)
Divalproex (Depakote): Main Uses
(Anticonvulsant)

1st line for mania & rapid cycling.

(L4-5, P5)
Carbamazepine (Tegretol): Main Uses
(Anticonvulsant)

1st line for mixed episodes.

2nd line for mania.

(L4-5, P5)
Divalproex (Depakote): Side Effects
(Anticonvulsant)

CNS - better tolerated than carbamazepine, less fatigue & dizziness.

GI - nausea, vomiting, & indigestion (but are usually transient).
Sustained-release tablets may reduce these side effects.

Interferes with normal blood-clotting cycle.

Cases of liver damage in children.

Blood level monitoring weekly for first 3 months, and then monthly.

Overdose causes somnolence & coma.

(L4-5, P5)
Carbamazepine (Tegretol): Side Effects
(Anticonvulsant)

CNS - sedation, dizziness, drowsiness, blurred vision, incoordination.

GI - nausea, vomiting, diarrhea, & abdominal pain.

Dermatological Effects - red, itching rash or hives.

Watch patients with history of cardiac problems and liver disease, because can reduce white blood cells.

Blood level monitoring weekly for first 3 months, and then monthly.

Toxicity causes neurological and cardiac malfunctions.

(L4-5, P5)
Anticonvulsants: Main Uses
[Call David Later - Then David Late]

Carbamazepine (Tegretol)
1st line for mixed episodes.
2nd line for mania.

Divalproex (Depakote)
1st line for mania & rapid cycling

Lamotrigine (Lamictal)
1st line for bipolar depression, acute and maintenance
2nd line for rapid cycling
[Newest medicine; used for bipolar II, maybe for bipolar I also.]

[Depakote & Tegretol are constantly used.]

(L4-5, P5)
3 Types of Anticonvulsants
[Call David Later - Then David Late]

1. Carbamazepine (Tegretol)
2. Divalproex (Depakote)
3. Lamotrigine (Lamictal)

(L4-5, P5)
Lithium's Side Effects: Monitoring Blood Levels
Initiation of treatment: 3-7 days for several weeks.

Routine treatment: Every 1-3 months

Dosage changes: 3-5 days.

Signs of toxicity: immediate measurements.

(L4-5, P4)
Bipolar Disorder Treatment: First & Second Line Agents, Adjunctive Treatments
[First choice is lithium, then Depakote.]

First line agent - lithium & divalproex (Depakote)

Second line agent - carbamazepine (Tegretol)

Anticonvulsants - valproic acid (e.g. Depakote, Tegretol).

Used today: mood stabilizers

Benzodiazepines or antipsychotics (e.g. Olanzapine) are antidepressant and adjunctive-like [i.e. adjunctive treatments].

[Benzodiazepines work really fast, so may use it initially for fast effect. Lithium is a bit slower.]
(L4-5, P3)
Bipolar II Disorder: Hypomanic Episode
Hypomanic episode last at least 4 days.

Change in functioning uncharacteristic of behavior.

Hypomania has no significant impairment, no hospitalization needed.

(L4-5, P2)
Bipolar II Disorder
1 or more major depressive episodes with at least 1 hypomanic episode.

Never manic or mixed episode.

Difficult diagnosis, sometimes patients are unable to recall the elated mood.

[Must be accompanied with major depressive episode. Can be diagnosed with Bipolar II when have at least 1 hypomanic episode.]

(L4-5, P2)
Bipolar I: Manic Episode
Distinct episode, elevated expansive or irritable mood at least 1 week.

Racing thoughts, pressured speech, grandiosity, increased activity, distractibility, engage in pleasurable activities, decreased need for sleep, with or without psychotic features.

[EXTREME pleasurable activities (e.g. extreme sexuality, using drugs).]

Can be abrupt or gradual stages.

Impaired occupational/social function, hospitalization.

(L4-5, P2)
Bipolar I Disorder
1 or more manic/mixed episodes, with or without a major depressive episode.

Manic episode is rarely a diagnosis on its own. Even without depressive episode, diagnosis of Bipolar I.

Impaired occupational/social function, hospitalization.

(L4-5, P2)
Bipolar Disorder
Disorders that follow cyclic patterns of mood, behavior, and thought alterations.

Alternates between mania, hypomania, and depression.

1. Bipolar I
2. Bipolar II
3. Cyclotimic
4. Undifferentiated [i.e. Not Otherwise Specified - NOS]

(L4-5, P1)
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