ATI Mental Health: Medications for Bipolar
Disorders
Mood Stabilizer - ANS-Lithium Carbonate
Effect - ANS-used in treatment of bipolar disorders: controls episodes of acute mania, helps to
prevent the return of mania or depression, and decreases the incidence of suicide
Complications - ANS--GI distress
-Find hand tremors (administer beta-adrenergic blocking agents like propranolol (Inderal) )
-polyuria, mild thirst (use a potassium-sparing diuretic, like spironolacone (Aldactone)
-weight gain
-renal toxicity
-goiter and hypothyroidism with long-term treatment (Obtain client's baseline T3, T4, and TSH
levels prior to starting treatment, advise client to monitor for signs for hypothyroidism: cold, dry
skin; decreased heart rate, weight gain; administer levothyroxine (synthroid))
-bradydysrhythmias, hypotension, electrolyte imbalances
Lithium toxicity - ANS-<1.5 mEq/L (early indications): diarrhea, nausea, vomiting, thirst, polyuria,
muscle weakness, find hand tremors, slurred speech
- instruct client to w/hold medication and notify provider
1.5-2.0 mEq/L (advanced indications) : mental confusion, poor coordination, coarse tremors,
and ongoing GI distress, including nausea, vomiting, diarrhea
-instruct client to withhold the medication, and notify provider
2.0-2.5 (severe toxicity)- extreme polyuria of dilute urine, tinnitus, blurred vision, ataxia,
seizures, sever hypotension leading to coma, and possible death from respiratory complications
- administer an emetic to alert clients, or administer gastric lavage
-urea, mannitol, or aminophylline may be prescribed to increase rate of excretion
>2.5 (severe toxicity): rapid progression of manifestations leading to coma and death
- hemodialysis may be warranted
Contraindications - ANS-- Lithium is considered teratogenic, especially during first trimester of
pregnancy
- discourage clients from breastfeeding with lithium therapy
-use cautiously in clients who have renal dysfunction, heart disease, sodium depletion, and
dehydration
Medication/food interactions - ANS-- diuretics- sodium is excreted with the use of diuretics; with
decreased serum sodium, lithium excretion is decreased, which can lead to toxicity
-NSAIDs- concurrent use will increase reabsorption of lithium
- Anticholingerics
Disorders
Mood Stabilizer - ANS-Lithium Carbonate
Effect - ANS-used in treatment of bipolar disorders: controls episodes of acute mania, helps to
prevent the return of mania or depression, and decreases the incidence of suicide
Complications - ANS--GI distress
-Find hand tremors (administer beta-adrenergic blocking agents like propranolol (Inderal) )
-polyuria, mild thirst (use a potassium-sparing diuretic, like spironolacone (Aldactone)
-weight gain
-renal toxicity
-goiter and hypothyroidism with long-term treatment (Obtain client's baseline T3, T4, and TSH
levels prior to starting treatment, advise client to monitor for signs for hypothyroidism: cold, dry
skin; decreased heart rate, weight gain; administer levothyroxine (synthroid))
-bradydysrhythmias, hypotension, electrolyte imbalances
Lithium toxicity - ANS-<1.5 mEq/L (early indications): diarrhea, nausea, vomiting, thirst, polyuria,
muscle weakness, find hand tremors, slurred speech
- instruct client to w/hold medication and notify provider
1.5-2.0 mEq/L (advanced indications) : mental confusion, poor coordination, coarse tremors,
and ongoing GI distress, including nausea, vomiting, diarrhea
-instruct client to withhold the medication, and notify provider
2.0-2.5 (severe toxicity)- extreme polyuria of dilute urine, tinnitus, blurred vision, ataxia,
seizures, sever hypotension leading to coma, and possible death from respiratory complications
- administer an emetic to alert clients, or administer gastric lavage
-urea, mannitol, or aminophylline may be prescribed to increase rate of excretion
>2.5 (severe toxicity): rapid progression of manifestations leading to coma and death
- hemodialysis may be warranted
Contraindications - ANS-- Lithium is considered teratogenic, especially during first trimester of
pregnancy
- discourage clients from breastfeeding with lithium therapy
-use cautiously in clients who have renal dysfunction, heart disease, sodium depletion, and
dehydration
Medication/food interactions - ANS-- diuretics- sodium is excreted with the use of diuretics; with
decreased serum sodium, lithium excretion is decreased, which can lead to toxicity
-NSAIDs- concurrent use will increase reabsorption of lithium
- Anticholingerics
