Alright. In this video, we are going to talk about medications that are used to treat bipolar
disorder. And we're going to start by talking about lithium which is a mood stabilizer.
If you are following along with cards, I'm on card 61. And you'll notice on the back of card 61,
there is a lot of bold, red items because there are a lot of things
that are important to know about lithium. So like I said, lithium treats bipolar disorder.
It works by influencing the reuptake of neurotransmitters. It has many side effects which
makes it difficult for patients to stay on this medication when they need it for bipolar disorder.
So side effects can include GI upset, fine hand tremors, polyuria due to nephrogenic diabetes
insipidus that lithium causes. Also weight gain is very common with lithium. Kidney toxicity is a
big risk with lithium and we'll talk a little bit more about that. Electrolyte imbalances, fatigue,
hypothyroidism, as well as leukocytosis, are other side effects to be familiar with.
So one way to remember at least some of these side effects is to think of the word lith.
So in the word lith, L stands for leukocytosis. I stands for insipidus which we'll hope hopefully
remind you that lithium can cause diabetes insipidus and polyuria.
T stands for tremors. So when a patient's on lithium, fine hand tremors are expected. If
those hand tremors turn into coarse hand tremors, that is indicative of toxicity.
And then, the H stands for hypothyroidism.
So lithium carries a black box warning because of the risk of lithium toxicity.
So when your patient is on lithium, you're going to want to closely monitor their plasma levels.
Plasma levels should stay under 1.5. If they get above 1.5, this can cause toxicity.
Signs of toxicity include coarse tremors, confusion, hypotension, seizures, and tinnitus.
If your patient's on lithium, you need to provide some very important teaching.
While the patient's on lithium, they need to maintain an adequate intake of both sodium
and fluids. And this is very important to know. Also, your patient needs to avoid certain
medications in order to prevent toxicity. One thing they should avoid is diuretics. Why? Well,
diuretics get rid of sodium and water. And that is the opposite of what we want
to do with lithium. So no diuretics. No anticholinergics and no NSAIDS.
So NSAIDS are hard on the kidneys. And since this medication already carries a
risk for kidney toxicity, we don't need to do any more damage to the kidneys.
So those are going to be some important medications that your patient should avoid.
In addition, if you have a patient who has renal disease, they would not take
lithium. It would be contraindicated. So hopefully, this information's been
helpful. Like I said, all of the things we've talked about are on the back of this card. And
they're important to know so definitely review those because you will likely need
to know those for the NCLEX and in all likelihood, your nursing exams as well.
Alright. Now let's talk about some anticonvulsants which are also used to help treat bipolar
disorder. So three medications that fall within this class that I'd be familiar with include
carbamazepine, valproic acid, and lamotrigine. These medications can be used for seizures
and epilepsy as well as for bipolar disorder. All three of these meds have some serious side
effects. And they all have a black box warning. So let's go through some of those key side effects.
So for carbamazepine, a key possible side effect are blood dyscrasias. So
these blood dyscrasias can include anemia, thrombocytopenia, as well as leukopenia.
In addition, carbamazepine has often caused issues with vision for patients.
And it can also result in hypo-osmolarity in patients. This is because with this drug,
it can cause SIADH or syndrome of inappropriate ADH. And this SIADH causes the retention of
all this water which dilutes the bloodstream and can result in this hypo-osmolarity.
And then serious skin rashes are also a risk with carbamazepine.
So like I said, this drug, as well as the other two we'll talk about,
does carry a black box warning. The black box warning for carbamazepine is due to the anemia,
the potential for serious skin rashes, as well as that leukopenia.
So when your patient is on carbamazepine, you're definitely going to want to monitor
their CBC levels because of the blood dyscrasias. And then you're also going to want to monitor
the patient for signs of infection because their white blood cell count is impacted,
which places them at higher risk for infection. So that's going to be another thing to watch out for.
Valproic acid also has some serious side effects. So these side effects can include
hepatotoxicity, pancreatitis, GI upset, as well as thrombocytopenia.
So valproic acid also carries a black box warning, specifically for that hepatotoxicity,
pancreatitis. And then it also carries a risk for causing neural tube defects in developing fetuses.
So if your patient is going to be on valproic acid, you're definitely going to want to monitor
their liver function. So you're going to be taking a look at their AST, ALT, and bilirubin levels
because of that serious risk for hepatotoxicity. And then, lastly with lamotrigine. Lamotrigine
does carry some risks as well, including dizziness, GI upset, photosensitivity, and rash.
And the black box warning for lamotrigine is because of the
risk for development of serious skin rashes. Okay. In my next video, we will talk about
medications that are used to treat psychotic disorders, including schizophrenia. If you
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