May 29, 2023


Hey guys nurse mike here and welcome to simple nursing calm before we get today’s lecture started please remember click here to check out our brand new app based nclex product loaded with the highest quality and click style practice questions and complete with detailed video rationales that break down the question for you so finally mastered all those darn select

All that apply questions plus all our nclex memberships come included with our entire library of over a thousand videos and study guides and cheat sheets come see why over a hundred thousand students have trusted their future to simple nursing calm click here to get started for free now for the bipolar medications first on the list is carbamazepine indication is

Obviously bipolar but also given for seizures and a big one here is for treatment of trigeminal neuralgia basically neuropathic pain now the side effect number one is leukopenia we have low wbc’s which means increased risk or massive infection so the key word here is to report fever and sore throat guys that’s the most important now next is accidental pregnancy so

Key words oral contraceptives are ineffective and we’ll need alternative forms of birth control or birth control methods now next is v for valve uric acid so guys just think vowel with a lot of owls so l for liver toxic we monitor for jaundice and liver labs alt s and ast s and l for low platelets aka thrombocytopenia we have a big bleed risk now the lp uruk acid

Is also not pregnancy safe and we teach clients not to discontinue abruptly now for the big momma lithium this is the drug to know coming up 22% of the time for all psychiatric meds so for lithium it’s given over the long-term treatment for both bipolar and schizoaffective disorder so guys the memory trick is a lithium battery since lithium lasts a long time and

B for bipolar remember battery now it has a very narrow therapeutic range 0.62 1.2 and the key point here is that toxicity happens over 1.5 so patients at highest risk for toxicity are those with decreased renal function remember kidneys are the washing machines of the body washing the blood out from medications and wastes so any decrease in real function usually

Sets the stage for toxicity so be cautious with patients in kidney disease and also elderly patients who naturally have decreased kidney function again the keys signs for the kidneys our creatinine over 1.3 means bad kidney and urine 30 mls per hour or less means kidneys are in distress and the signs and symptoms of tinnitus ringing of the ears usually indicates

Some type of kidney malfunction so we use the acronym lift for all the key points that are highly tested l4 levels over one point five equals huge toxicity so blood levels are drawn regularly to maintain that therapeutic dose and may take up to three weeks so guys a common test question is lithium at a therapeutic level if yes then continue at the current dose now

I is for increasing fluid and sodium since lithium lets go of the fluid guys the big key point here and the contraindication is we can’t give lithium during dehydration and low sodium that hyponatremia below 1 3 5 micro equivalence per liter guys always question any prescription the doctor writes if the patient has low sodium or dehydration second thing is never

Restrict sodium and water key word here do not limit sodium intake since sodium swells the body with water we need to avoid that toxicity here now a typical question is a patient at highest risk for toxicity usually a patient with a stomach flu including diarrhea and vomiting now the big key words here are due to massive dehydration again always reviewing low sodium

If below 135 we’re reporting to the doctor or hcp and we teach patients to avoid the dehydration by teaching them to drink 1 to 3 liters of water per day and limit diuretics including foods that have diuretic properties like coffee colas and teas guys we want more fluid in and less fluid out so again here know diuretics like furosemide or hydrochlorothiazide and

No anticholinergic medications like the respiratory med ipratropium because they dry you out again we think pm’s you can’t pee with them now our tea is for toxic signs when to report to the hcp so guys write these keywords down report excessive urination and extreme thirst guys these both lead to dehydration and more toxicity now vomiting and diarrhea which can

Add more dehydration and again more toxicity and third neuromuscular excitability like tremors and my colonic jerks or horse hand tremors and even a taxi ax confusion or agitation guys the number one intervention by the nurse is always to increase the fluids now h is for hold the nsaids like ibuprofen and naproxen remember nsaids are really bad for the entire body

Especially the kidneys so the key point nsaids like ibuprofen they decrease renal blood flow increasing the risk for toxicity so guys we need to avoid those and if the patient wants to take it we need further teaching so use a city of men afine like tylenol instead now common expected side effects that we don’t need a report guys the dry mouth and the thirst so

Teach patients to use ice chips gum or sugarless candy and drink plenty of fluids and also do oral hygiene now drowsiness and fatigue teach patients to avoid driving as well as hazardous activities until that improves and we have weight gain so we teach proper diet and exercise and decreased appetite if the patient has weight loss its anorexia and mild gi upset

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Transcribed from video
Pharmacology – Bipolar Drugs – Lithium, Valproic Acid, Carbamazepine nursing RN PN NCLEX By Simple NursingliveBroadcastDetails{isLiveNowfalsestartTimestamp2020-08-13T023009+0000endTimestamp2020-08-13T023924+0000}