Psychiatric Mental Health, part 22: Therapies - Bipolar Disorder Medications
by Cathy Parkes May 29, 2023 Updated: August 10, 2023 4 min read
Hi, I'm Cathy with Level Up RN. In this video, I will be discussing medications that are used in the treatment of bipolar disorder. This includes mood stabilizers, as well as anticonvulsants, which are used to treat seizures in addition to bipolar disorder. At the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in the video, so definitely stay tuned for that. And if you have our Level Up RN Psychiatric Mental Health Nursing flashcards, definitely pull those out so you can follow along with me, and pay close attention to the bold red text on these cards because these drug classes are highly tested on in nursing school and those bold red items are likely to show up on a nursing school exam.
Lithium is a key mood stabilizer used in the treatment of bipolar disorder. And the way I remember that lithium is used for bipolar disorder is I think of the album Lithium that the band Nirvana put out years ago. Some of you guys may be familiar with Nirvana. The lead singer of Nirvana was Kurt Cobain, who is no longer with us. It is reported that Kurt Cobain had bipolar disorder. So when I think of bipolar disorder, I think of Kurt Cobain and the album Lithium that he and his band put out. Lithium has a lot of side effects, which makes it really difficult for patients to stay on this medication. A key side effect of lithium is nephrotoxicity, which is why this medication is contraindicated in patients with renal disease. Other side effects include polyuria, increased thirst, fine hand tremors, hypothyroidism, electrolyte imbalances, leukocytosis, GI upset, weight gain, as well as fatigue.
When your patient is on lithium, it's going to be really important that you monitor their serum levels throughout therapy because lithium toxicity is a big concern with this medication. Therapeutic serum levels of lithium are between 0.6 and 1.2. Anything over 1.5 is indicative of toxicity. Signs and symptoms of toxicity include coarse hand tremors. So fine hand tremors are expected. Those are a known side effect of lithium. But coarse hand tremors are indicative of toxicity. Other signs and symptoms of toxicity include confusion, hypotension, seizures, as well as tinnitus. In addition to monitoring serum levels of lithium, we will also need to monitor our patient's creatinine and BUN levels due to the risk of nephrotoxicity.
In addition, we need to monitor our patient's sodium levels. This is super important. So sodium and lithium have an inverse relationship. So as sodium levels go down, lithium levels go up. So it's imperative that we teach our patient the importance of getting enough sodium intake throughout therapy. In addition to making sure our patient is getting adequate sodium intake, we also need to teach our patient to get adequate fluid intake. So patients should avoid activities that cause excessive sweating, which results in the loss of fluid and sodium, which is not what we want. They should also report any illnesses with vomiting to their provider right away. And then finally, it's important to know that diuretics and NSAIDs are contraindicated when the patient is taking lithium. So diuretics get rid of sodium and fluid, which is the opposite of what we want. So that is why diuretics are contraindicated. And then NSAIDs are hard on the kidneys and they also increase levels of lithium. So that is why NSAIDs are contraindicated during lithium therapy. So I know I threw down a lot of information about lithium. And that's why, really, repetition is key in nursing school and that is why flashcards were my secret weapon when I was going to nursing school.
Let's now talk about two key anticonvulsants that are used to treat seizures but are also effective in the treatment of bipolar disorder. This includes carbamazepine and valproic acid. Let's first talk about carbamazepine. The mode of action of carbamazepine is to decrease synaptic transmission in the central nervous system, which helps to decrease mania associated with bipolar disorder. A key side effect of carbamazepine is blood dyscrasias. So this includes anemia, leukopenia, and thrombocytopenia. So we have a decrease in red blood cells, white blood cells, as well as platelets. Our cool chicken hint to help you remember this important side effect is my love of carbs is in my blood. And that is definitely the case for me. Given this important side effect, as the nurse, you are going to monitor the patient's CBC levels throughout therapy. Other side effects of carbamazepine can include vision issues as well as the potential for serious rashes.
Moving on to valproic acid now. The mode of action of valproic acid is to increase levels of GABA, which is an inhibitory neurotransmitter in the central nervous system. And this in turn decreases manic episodes associated with bipolar disorder. Key side effects of valproic acid include hepatotoxicity, pancreatitis, as well as thrombocytopenia. Our cool chicken hint to help you remember that valproic acid causes liver damage is if you value your liver, then be careful when taking valproic acid. Given this important side effect, as the nurse, you will want to monitor your patient's liver function throughout therapy, which includes their AST and ALT levels.
All right, it's quiz time. Are you guys ready? I've got three questions for you. Question number one. Lithium serum levels over blank milliequivalents per liter are indicative of toxicity. The answer is 1.5. Question number two. Fine hand tremors are indicative of lithium toxicity. True or false? The answer is false. Fine hand tremors are an expected side effect of lithium, as opposed to coarse hand tremors, which are indicative of lithium toxicity. Question number three. Which anticonvulsant used in the treatment of bipolar disorder carries a key side effect of hepatotoxicity? The answer is valproic acid. All right, I hope you did great with that quiz and I hope you found this video to be helpful. If so, be sure to hit that like button. Take care and thank you so much for watching.
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