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This 10 page Class Notes was uploaded by Orie Bauch I on Wednesday September 23, 2015. The Class Notes belongs to NURS301 at Drexel University taught by ReginaWright in Fall. Since its upload, it has received 24 views. For similar materials see /class/212347/nurs301-drexel-university in Nursing and Health Sciences at Drexel University.
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Date Created: 09/23/15
Drugs for Bipolar Disorder N301 Pharmacology Professor Regina Wright Bipolar Disorder Mood Episode Types Pure Manic Episode Euphoric Mania u Hyperactivity excessive enthusiasm flight of ideas a Overactivity at work and play high risk behaviors o Severe cases may resemble paranoid schizophrenia Hypomanic Episode Hypomania u Mild form of mania a Does not cause marked impairment in social or occupational functioning o Psychotic symptoms are absent Major Depressive Episode depression a High risk of suicide Mixed Episode o Agitated and irritable feel worthless and depressed a High risk of suicide Bipolar Disorders Characteristics Recurrent fluctuations in moods alternating between elevated and depressed Patterns of Mood Episodes 1 Mood between episodes varies Vary in duration and frequency Examples mania repeated depression with occasional episode of mania mixed mood Bipolar Disorder Treatment a Psychotherapy u Mood stabilizers amp Mood stabilizing Anticonvulsants Relieve symptoms during manic and depressive episodes I Prevent recurrence Do not worsen symptoms or accelerate cycling a Antidepressants ln BPD combine with a mood stabilizerto prevent mania or hypomania a Antipsychotics I Control symptoms during severe manic episodes I Used in combination with a mood stabilizer Lithium Therapeutic Uses a controlling acute manic episodes and long term prophylaxis against recurrence Narrow therapeutic index Short half life requires divided daily doses in Individualized dosing based on plasma levels and clinical response Excreted in kidneys caution in renal impairment Lithium I Lithium 1 Renal excretion of lithium is affected by blood levels of sodium 1 lsodium level gt llithium excretion a The kidneys process lithium and sodium the same way When the kidneys sense sodium levels are inadequate it retains lithium in an attempt to compensate risk for toxicity Lithium u Levels Maintenance levels 0410 mEqliter a Initial therapy 08 14 mEqIiter El Remember keep below 14 mEqliter I Draw levels in the am 12 hours afterthe evening close Measure every 23 days at beginning of treatment 13 months during maintenance a Effects at Therapeutic levels GI upset transient fatigue muscle weakness HA confusion and memory impairment Tremor Drug interactions in Diuretics NSAle not ASA though a Anticholinergics think urinary retention Pregnancy category D Mood Stabilizing Anticpileptic Valproic Acid Depakote a Control symptoms in acute manic episodes and prophylaxis against recurrent episodes of mania and depression a Drug of choice for many patients 1 Works faster highertherapeutic index than lithium Valproic Acid Depakote I Adverse effects a Thrombocytopenia u Pancreatitis 1 Liver failure El GI Weightgain GI upset u Teratogenic Key Points Importance of psychotherapy Recognition of symptoms Electrolyte balance with lithium Contrast differences in drug classes
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