Bipolar Medications Quiz

Lithium Therapy Considerations and Patient Management

• Lithium doses should start low and increase gradually based on serum drug levels and symptoms control
• Serum drug level measurements are crucial due to narrow therapeutic range and individual variations
• Adequate renal function is essential for lithium therapy, as sodium levels affect lithium reabsorption
• Caution is needed when using lithium in patients with hepatic impairment and critical illness
• Discontinuation of lithium is necessary before surgery and may prolong the effects of anesthetics
• Common adverse effects of lithium include metallic taste, hand tremors, nausea, and weight gain
• Contraindications for lithium therapy include known sensitivity to the drug and pregnancy
• Several drugs can interact with lithium, either increasing or decreasing its effects
• Baseline studies of renal, cardiac, and thyroid status are essential before starting lithium therapy
• Serum lithium levels should be monitored regularly, with the therapeutic range being 0.5 to 1.2 mEq/L
• Lithium should be taken with food to reduce the risk of nausea and vomiting
• Patient teaching should emphasize the importance of taking lithium as directed, maintaining regular blood tests, and avoiding dehydration and excessive sweating

Mood-Stabilizing Agents: Drugs Used to Treat Bipolar Disorder

• Lithium’s mechanism of action is not fully understood, but it is believed to affect the destruction of catecholamines, inhibit neurotransmitter release, and decrease sensitivity of postsynaptic receptors.
• Lithium's action peaks in 30 minutes to 4 hours for regular forms and 4 to 6 hours for slow-release form, crossing the blood-brain barrier and placenta, and is distributed in sweat and breast milk.
• Lithium use during pregnancy is not recommended due to potential first-trimester developmental abnormalities.
• Onset of action for lithium is 5 to 14 days, and combination with antipsychotic or antidepressant agents is used to reduce symptoms in acutely manic or depressed clients.
• The half-life of lithium is 20 to 27 hours.
• About 75% of people with bipolar illness respond effectively to lithium, while the rest may have difficulty taking it due to side effects, treatment regimen, drug interactions, or medical conditions.
• Anticonvulsants like carbamazepine, valproic acid, gabapentin, lamotrigine, topiramate, and clonazepam are used as mood stabilizers for bipolar illness, each requiring specific therapeutic level monitoring and baseline laboratory testing.
• Aripiprazole, brexpiprazole, cariprazine, ziprasidone, lurasidone, and quetiapine are adjunctive medications used alongside mood stabilizers or antidepressants to treat bipolar disorder.
• Research has shown that mood-stabilizing drugs like lithium stimulate neuronal growth and reduce brain atrophy in people with long-standing mood disorders.
• Lithium carbonate is used to treat and prevent manic episodes in bipolar disorder, proving effective in controlling mania and decreasing the frequency and intensity of manic cycles.
• Lithium is well absorbed after oral administration, with peak serum levels in 1 to 3 hours and steady-state concentrations in 5 to 7 days, and is entirely excreted by the kidneys.
• Lithium is the drug of choice for treating manic episodes of bipolar disorder and for maintenance treatment, with long-term therapy being usual practice to decrease recurrence. Gradually tapering the dose over 2 to 4 weeks delays the recurrence of symptoms.