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Mood Disorders Part II
Bipolar
72
Nursing
Graduate
06/19/2011

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Cards

Term
Bipolar Disorder has a strong ______ component. Twins who are Bipolar have a ___-____% chance of having it. There is also an _____ component. If a parent has Bipolar disorder, tehre's a ____% chance their child will have it. If both parents have it, there's an __% chance child will have it, even if child is ______ to another _____.
Definition
Hereditary, 10-20%
28%
80% if both have it, even if child is adopted to another family.
Term
Bipolar disorder is associated with ______ of ______, _______, and/or ________
Definition
excess of norepinephrine, serotonin and/or dopamine
Term
Bipolar disorder may have to do with an _______ imbalance. Particularly, high levels of _________ ___. If that is the cause, _______ _______ _________ will be and effective medication.
Definition
Electrolyte imbalance

High levels of intracellular calcium.

Calcium channel blockers will be effective.
Term
A ______ on the ____side of brain may cause secondary ____ symptoms
Definition
tumor (or lesion) on the right side of the brain may cause secondary mania symptoms
Term
Medications like ____ and _______ for another reason they may have mania symptoms
Definition
steroids or amphetamines
Term
_________ theories associated with bipolar disorder have declined over the years, though ______ probably does play a role.
Definition
psychosocial, environment
Term
About _% of children are bipolar
Definition
1%
Term
What does FIND stand for? For whom is it used?
Definition
Frequency of symptoms: symptoms occur most days of the week
Intensity of symptoms: cause extreme disturbance
Number of symptoms: 3-4x day
Duration of symptoms: 4 or more times an hour

Diagnosing children and adolescence with bipolar
Term
It's challenging to differentiate ______ ______ and _______ in children.
Definition
Bipolar disorder and ADHD

*note if child isn't responding to ADHD medication, could it be bipolar as well?
Term
________ may be present in Bipolar disorder
Definition
Psychosis (hallucinations.delusions)
Term
_____ ____ may exacerbate mania symptoms, and they should be administered only ______ symptoms have been controlled
Definition
ADHD agents may exacerbate symptoms and should be administered only after symptoms have been controlled
Term
One of the scariest symptoms of Bipolar in adolescence is that they seek _____/_____ activities
Definition
pleasurable/risky
Term
Some medications used in treating bipolar diorder in children are: ______, ________, _______, as well as _____ antipsychotics (like ______ ). The goal is to give ___ medication at ___ ____.
Definition
Lithium, divalproex, carbamazepine, atypical antipsychotics (like abiliphy)
Goal is to try one medication at a time.
Term
_____ is the most common comorbid condition in bipolar disorder in teens and children
Definition
ADHD
Term
There is no _____ for bipolar disorder, but if it is recognized and treated early they may be able to taper off of medications. The majority of people need a ____ _____ ____.
Definition
No cure.

may be tapered off, but most need life-long treatment.
Term
Stage I of bipolar disorder:
Definition
Least severe.
Hypomania: symptoms not sufficiently severe to cause marked impairment or require hospitalization.

Mood is cheerful, expansive
Cognition and perception: self-exultation; easily distracted
Activity and behavior: increased motor activity; extroverted, superficial
Term
Stage II bipolar
Definition
Acute Mania: intensification of hypomanic symptoms

Requires hospitalization*

Euphoric, elated mood.
Fragmented, disjointed thinking, *difficulty staying on point, pressured speech, flight of ideas, hallucinations and delusions

Increased sexual activity, excessive psychomotor behavior, inexhaustible energy, goes without sleep *bizzarre dress and makeup.

May be very manipulative to get people to behave like them
Term
Stage III bipolar
Definition
Delerious Mania

A grave form of the disorder

Severe clouding of consciousness and representing an intensification of the symptoms associated with acute mania

Has become rare since the availability of antipsychotic medication
Term
Due to inability to stop to eat, a manic person may show _____, ______
Definition
Weight loss, amenorrhea

High calorie, finger foods are ideal
Term
The most serious nursing diagnoses for manic behavior are
Definition
risk for injury
risk for violence self-directed/toward others
Term
It is important that ______ and _____ are educated about bipolar disorder, and they should know that this is a _______ disorder. So if they see symptoms worsen, they should call the doctor so that lithium levels can be checked.
Definition
Family and friends
Cyclical disorder
Term
Lithium levels should be checked _____ or _____ at the beginning of treatment (until patient is very stable on a therapeutic level)
Definition
weekly or biweekly
Term
Phase I of individual psychotherapy behavior
Definition
Determine extent of person's illness

Develop trusting relationship with patient
Term
Phase II of individual psychotherapy

____ of therapy takes place, May last _____ or _______. Many times _______ _______ needs to be resolved. __________ in relationships with others that needs to be explored.
Definition
Work phase of therapy
May last months or years

Dysfunction grief is worked through

Ambivalence in relationships with others
Term
Phase III is _________
Definition
termination of therapy
Term
_______ therapy tells patient they are not alone
Definition
Group therapy
Term
____ therapy is when patients begin to recognized own dysfunctional thought process.
Definition
Cognitive therapy
Term
What kind of mania do they have (types)
Definition
euphoria, elation

anger, irritability, rage

exaggerated sense of ability

emotional liability
Term
When hyperactivity starts, you should...?
Definition
Remove client from stimulating environment
Term
Lithium carbonate (Eskalith, Lithane)
Definition
Antimanic medication. "The original drug."
Term
Why do bipolar people take anticonvulsants?
Definition
seizure activity and mania are similar
Term
Carbamazepine (Tegretol)
Definition
Anticonvulsant
Term
Clonazepam (Klonopin)
Definition
Anticonvulsant
Term
gabapentin (Neurontin)
Definition
anticonvulsant
Term
Lamotrigine (Lamactal)
Definition
Anticonvulsant
Term
Topiramate (Topamax)
Definition
anticonvulsant
Term
valproic acid (Depakote, Depkene)
Definition
Anticonvulsant
Term
Antipsychotics
Definition
Aripiprazole (Abilify)*
Chlorpromazine (Thorazine)*
Olanzapine (Zyprexa)
Quetapine (Seroquel)
Risperidone (Risperdol)
Ziprasidone (Geodon)
Term
Aripiprazole (Abilify)*
Definition
Antipsychotic
Term
Chlorpromazine (Thorazine)*
Definition
Antipsychotic
Term
Olanzapine (Zyprexa)
Definition
Antipsychotic
Term
Quetapine (Seroquel)
Definition
Antipsychotic
Term
Risperidone (Risperdol)
Ziprasidone (Geodon)
Definition
Antipsychotics
Term
The mechanism of action in Lithium is ____ _____. It is a ______ that competes for ____ ______. It is thought to normalize reuptake of several _______ and it is effective for about ___% of clients.
Definition
Mechanism-->poorly understood
Salt that competes for salt receptors
neurotransmitters
Effective for about 75% of clients
Term
The serum half life of Lithium is ____. It is metabolized in the ______.
Definition
24 hours
metabolized in the kidneys
Term
Lithium is similar to ____ in structure. If _______ level is low, Lithium will be ________ rather than ______ by the kidneys.
Definition
Similar structure to sodium.

If sodium is low, Lithium will be reabsorbed rather than excreted by the kidneys
Term
Upon initiation of Lithium, blood levels are drawn every ________, until therapeutic level is reached
Definition
1-3 days
Term
*When acute symptoms are resolved, Lithium is _____ for ______ _____. This dose is ____ to ____ the ____ does. Then, blood levels are drawn every ______, or when ________________
Definition
Lithium is decreased for maintenance treatment

1/2 - 2/3 the acute does

Blood levels are drawn every 2-3 months or when a problem is suspected
Term
Antipsychotic drugs are specifically designed for the ______ and _______ they are having. It will _____ ______, but not _______ the mania. They must be used in combination with the _____________ or _________.
Definition
hallucinations and delusions

treat psychosis, but not stop the mania

used in combination with the antimanic or anticonvulsants
Term
Side effects of lithium
Definition
Drowsiness, headache, dry mouth, thirst Gi upset, N/V, fine hand tremors, hypotension, arrhythmias, pulse irregularities, polyuria, dehydration, weight gain, potential for toxicity
Term
Lithium is prescribed for ______ and ______. _________ clients are sensitive to toxicity due to _____ _____ ____. It is no recommended during ______ and _____.
Definition
Children and adults

Elder clients are sensitive to toxicity due to decreased renal function

Not recommended for pregnancy or lactation
Term
Lithium Contraindications (3)
Definition
1. Hypersensitivity
2. Renal disease
3. Thyroid disease
Term
Decreased levels of lithium may occur with 5 medications
Definition
1. acetazolamide
2. theophylline
3. mannitol and other osmotic diuretics
4. sodium bicarbonate
5. xanthines
Term
Increased toxicity of lithium occurs when used in conjunction with 5 meds
Definition
1. anesthetics
2. ACE inhibitors
3. NSAIDS
4. tetracycline
5. thiazide diuretics
Term
*How does sodium intake effect lithium toxicity
Definition
sodium intake LESS than 2g/day

sodium and fluids lost due to excessive exercise, dehydration, gi illness, fluid intake less than 6-8 glasses a day
Term
*Nursing interventions to prevent lithium toxicity: restrict _____ intake, maintain adequate _____ and _______ intake, contact health care provider for ______ _____ symptoms, inform all healthcare providers about lithium therapy especially when _______ is planned contact Dr. if signs of ________, maintain appointments for _____
Definition
restrict caffeine
maintain adequate h2o and sodium
contact dr with s/s of toxicity
inform all heathcare providers of lithium, especially if surgery is planned*
maintain appts. for blood levels
Term
*Normal therapeutic blood level for lithium is ____ to _____. Greater than ____ is toxic.
Definition
*0.6 to 1.2 --> therapeutic

*Greater than 1.5 ---> toxic
Term
Mild Lithium toxicity is a range of ___-____. S/S are: ______, decreased ______, mild _____, confusion, ______ speech, hand ______ and muscle ______
Definition
Mild toxicity ---> 1.5- 2.0

Apathy, decreased concentration, mild ataxia, muscle weakness, hand tremors, muscle twitching
Term
Moderate lithium toxicity s/s are: severe _____, ____, moderate ______, confusion, ______ speech, ________, ________, ________
Definition
Moderate lithium toxicity ---> 2.0-3.0 Severe diarrhea, nausea and vomiting, moderate ataxia, confusion, slurred speech, *tinnitus, *hyperflexia, *pruritis
Term
Severe lithium toxicity

S/S: ______, muscle ______, ______, cardiac ______, decreased _____, ______-_____ seizures, coma, _____
Definition
severe toxicity >3.0

Nystagmus, muscle fasiculations, hyperflexia, cardiac arrhythmia, decreased LOC, tonic-clonic seizures, coma, death
Term
The nurse notes a patient is disinterested in attending a group he has previously always attended. She prepares to give him his daily does of Lithium and notes a slight nose bleed. She should...?
Definition
Withhold lithium (even if toxicity is only suspected)
Obtain immediate serum lithium level
Monitor VS, electrolytes, BUN and creatinine
Administer IV of normal saline
Term
For SEVERE lithium toxicity, ________ is needed
Definition
hemodyalysis
Term
Thyroid impairment is a _____ _____ _____ of lithium treatment. Thyroid function studies should be monitored every __________ on clients receiving _________ _______ treatment
Definition
Serious side effect

Thyroid function studies ever 3-6 months on clients receiving long-term treatment
Term
_____ _____ is a serious side effect of lithium treatment and _____ function studies should be done every _-_ _____ on clients with long term lithium treatment
Definition
Renal impairment

Renal function studies ---> 3-6 months for clients on long term lithium treatment
Term
Anticonvulsants stimulate ______, which produces a _____ effect
Definition
GABA
calming
Term
There is a range in the serum half life of ___________, depending on which is being used. Tegretol or carbamazepine has a half-life of ___-___ ____, while the serum half life of valproic acid (Depakote) is _______. For both drugs ____ _____ are monitored.
Definition
Range in serum half life of anticonvulsants

Tegretol (carbamazepine)---->15-30 hours
Depakote (valproid acid)----> 8 hours
Term
contraindications of anticonvulsants
Definition
cardiovascular disease, hepatic disease, hypersensitivity reactions, blood dyscrasias (ex leukemia and hemophilia)
Term
Interactions specifically associated with carbamazepine (Tegretol): potential INCREASED levels
Definition
Potential increased levles with: erythromycin, cimetidine, proproxyphene, isoniazid, channel blockers, SSRIs
Term
Potential DECREASED levels associated with carbamazepine (Tegretol)
Definition
Potential decreased levels:
with divalproex, phenytoin, phenobarbital
Term
carbamazepine (Tegretol) may decrease the levels of other medications:
Definition
oral contraceptives, wafarin, theopyline, antipsychotics, divalroex
Term
There is a potential for increased levels of valproic acid (Depakote) when taken with _______. It also increases the effects of 6 other substances. There is an increased risk of seizure when taken with _____ or _____.
Definition
Aspirin

increases the effect of alcohol, warfarin, aspirin, phenobarbitol, primidone, MAOIs

Increased seizures --->phenytoin or clonazepam
Term
Serious side effects of anticonvulsant medications include _____ _____ and ________
Definition
hepatic toxicity and agranulocytosis
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