Bipolar
What are the therapeutic levels of lithium and when does toxicity start?
What is 0.6-1.2, toxicity starts at 1.5
What age group is at high risk for suicidal thoughts and are unlikely to tell anyone they are depressed or suicidal?
Older adults, especially if in a long-term care facility. Loneliness is a big risk factor and poor health and changes in lifestyles they are unwilling to make.
What is the MOST important point should you discuss when educating a patient taking an SNRI?
What is do not stop the medication abruptly.
What is salt. A patient on lithium should consume a steady diet of Na+. They do not need to increase or decrease their Na+. Their diet just needs to be consistent. They should avoid activities where they could sweat a lot if that is not a normal activity for them. The drug levels will be based off of the patient's normal patterns.
What are the signs of lithium toxicity?
What is nausea and vomiting.
What type of foods should be given to a patient in a manic state?
What is high calorie finger foods.
What is our biggest concern when caring for a patient with major depressive disorder?
What is safety. We are most concerned with the risk of suicide. We need to assess the risk.
What is the main concern the nurse should assess for when a patient is taking a SNRI? Describe what it is .
What is Serotonin Syndrome?
Serotonin Syndrome happens when you have too much serotonin. Symptoms include agitation, restlessness, insomnia, confusion, rapid heart rate, high blood pressure, dilated pupils, and twitching muscles.
What do most names of benzodiazepines end in?
Pam or lam
What should a bipolar patient on Lithium take for pain?
What is acetaminophen. Avoid NSAIDs like ibuprofen.
What is cyclothymic disorder?
What is alternating bouts of depression with hypomania for at least 2 years.
When is a patient most likely to commit suicide?
What is when depression is lifting. This could be after starting an antidepressant. It can take antidepressants a few weeks to start get desired affects. Advice patients to seek help if they have suicidal thoughts after starting new medication.
What are three herbal medications you should not take with SNRIs?
What are kava, valerian, and St. John's Wort
What lab value should be monitored with Tegretol (carbamazepine)?
What is a CBC to monitor for pancytopenia.
What medication is given for anxiety that can be ordered PRN and has an immediate onset?
What is benzodiazepines. SSRI's take time (usually a few weeks) to bring down anxiety.
What is disorganized speech, grandiosity delusions, and restlessness.
What is the difference between a major depressive episode vs a major depressive disorder?
What are three major side effects of SNRIs?
What is nausea, vomiting, weight loss, headache, insomnia, hypertension, tachycardia, dizziness, sexual dysfunction
What are the three anticonvulsants used to help stabalize moods of bipolar patients?
Depakene (valproic Acid)
Lamical (lamotrigine)
Tegretol (cabamazepine)
What is an example of an atypical anti-anxiety medication?
What is buspirone.
What is the best way to distract a patient with bipolar disorder that is in a manic phase?
What is walk with the patient. Avoid high stimulus activities. The patient will not be able to focus or sit still.
What are the most common side effects of SSRIs?
sexual dysfunction, weight gain, hyponatremia, bruxism, CNS stimulation causing inability to sleep.
What changes to vital signs would we observe for a patient taking a SNRI for
What is tachycardia and hypertension because of the increase in norephinephrine.
What are 3 foods that should be avoided with MAOIs? What should those foods be avoided while a patient is on a MAOI?
What is aged cheeses, wine/beer, and smoked meats.
Tyramine found in some foods such as those listed above can cause a hypertensive crisis if used with MAOIs.
What labs should be monitored with valproic acid (Depakene)? Why?
What is LFTs, Amy/lipase, CBC.
Hepatotoxicity, pancreatitis, and thrombocytopenia.