39 Questions
What is the primary lifetime regimen of medications for bipolar disorder?
Antimanic agent called lithium
What percentage of response rate in acute mania is observed with lithium therapy?
70% to 80%
What is the impact of lithium on bipolar disorder?
Reduces the degree and frequency of cycling
In addition to lithium, what may be administered if a client exhibits psychosis during acute mania or depression?
Antipsychotic agent
What is crucial for lithium therapy due to its narrow therapeutic range and individual variations?
Regular serum drug level measurements
Why is adequate renal function essential for lithium therapy?
Sodium levels affect lithium reabsorption
What is a common adverse effect of lithium therapy?
Hand tremors
What should patient teaching emphasize regarding lithium therapy?
Importance of taking lithium as directed and maintaining regular blood tests
What are contraindications for lithium therapy?
Known sensitivity to the drug and pregnancy
Why is caution needed when using lithium in patients with hepatic impairment and critical illness?
It may prolong the effects of anesthetics
What is the therapeutic range for serum lithium levels?
0.5 to 1.2 mEq/L
When should lithium be discontinued?
Before surgery
Why should lithium be taken with food?
To reduce the risk of nausea and vomiting
What should baseline studies include before starting lithium therapy?
Renal, cardiac, and thyroid status
What can interact with lithium, either increasing or decreasing its effects?
Several drugs
What is necessary for the dose of lithium to start with?
Low and increase gradually
What is the recommended action regarding lithium use during pregnancy?
It is not recommended due to potential first-trimester developmental abnormalities
What is the onset of action for lithium?
5 to 14 days
How is lithium excreted from the body?
Entirely by the kidneys
What is the recommended long-term therapy practice for treating bipolar disorder with lithium?
Gradually tapering the dose over 2 to 4 weeks
What is the half-life of lithium?
20 to 27 hours
What is the primary route of excretion for lithium?
Through the kidneys
What is the impact of lithium on the frequency and intensity of manic cycles in bipolar disorder?
Decreases the frequency and intensity of manic cycles
What is the distribution of lithium in the body?
Crosses the blood-brain barrier and placenta, and is distributed in sweat and breast milk
What is the response rate of people with bipolar illness to lithium?
About 75%
What is the mechanism of action of lithium believed to affect?
Destruction of catecholamines, inhibition of neurotransmitter release, and decrease in sensitivity of postsynaptic receptors
What is the effect of long-term lithium use on people with long-standing mood disorders?
Stimulates neuronal growth and reduces brain atrophy
What is the recommended approach to reducing symptoms in acutely manic or depressed clients using lithium?
Combination with antipsychotic or antidepressant agents
Which atypical antipsychotic is approved by the FDA for use in adolescents aged 10 to 17 years with type I bipolar disorder?
Risperidone
Which atypical antipsychotic has a Black Box Warning for the development of compulsive or uncontrollable urges to gamble, shop, binge eat, or have sex?
Aripiprazole
Which atypical antipsychotic is not recommended for dementia-related psychosis?
Quetiapine
Which atypical antipsychotic has antagonist effects on serotonin and dopamine?
Quetiapine
Which atypical antipsychotic has a Black Box Warning reporting increasing mortality in elderly patients with dementia-related psychosis?
Risperidone
Which atypical antipsychotic is used for the treatment of bipolar disorder in adults and has adverse effects including dizziness, drowsiness, and lightheadedness?
Ziprasidone
Which antipsychotic drug is predominately excreted in the urine and feces, and has reported adverse effects including somnolence, extrapyramidal symptoms, dizziness, weight gain, constipation, and xerostomia?
Olanzapine
Which antipsychotic drug is well absorbed with oral administration, highly protein bound, metabolized in the liver, and excreted in the urine and feces?
Aripiprazole
Which antipsychotic drug is used as monotherapy for the treatment of acute, mixed, or manic episodes associated with bipolar disorder and in combination with fluoxetine for the treatment of depressive episodes associated with bipolar disorder?
Olanzapine
Which antipsychotic drug is an atypical antipsychotic used for the treatment of bipolar disorder and schizophrenia, and has adverse effects including headache, somnolence, sedation, fatigue, dizziness, nausea, and vomiting?
Aripiprazole
Which antipsychotic drug is used alone or in combination with lithium or valproate for the treatment of acute mania or mixed episodes, and has adverse effects including significant weight gain, insomnia, sexual dysfunction, and photosensitivity?
Risperidone
Study Notes
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.
Test your knowledge of lithium therapy considerations and mood-stabilizing agents used to treat bipolar disorder with this informative quiz. Questions cover dosing, monitoring, adverse effects, drug interactions, and patient management for lithium therapy, as well as the mechanisms of action, onset of action, pregnancy considerations, and adjunctive medications for mood-stabilizing agents.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
