Overview
This lecture covers the main medication therapies for bipolar disorder and schizophrenia, focusing on drug classes, mechanisms, side effects, and key nursing considerations.
Medication Therapy for Bipolar Disorder
- Bipolar disorder involves mood swings between mania (highs) and depression (lows).
- Mood stabilizers are the primary treatment; lithium carbonate is the gold standard.
- Lithium modulates neurotransmitters (dopamine, GABA, glutamate) to stabilize mood.
- Therapeutic lithium range: 0.8–1.2 mEq/L; requires regular blood level monitoring.
- Common lithium side effects: nausea, hand tremors, increased thirst (polydipsia), frequent urination (polyuria), and risk of hypothyroidism.
- Signs of lithium toxicity: early (muscle weakness, confusion, excessive thirst) and severe (seizures, coma, arrhythmia, death).
- Patients must maintain adequate sodium and hydration; dehydration increases toxicity risk.
- Avoid NSAIDs with lithium due to increased toxicity risk.
- Anti-seizure drugs (valproic acid, carbamazepine, lamotrigine) can also be used as mood stabilizers.
- Valproic acid: raises GABA, risk of weight gain, sedation, tremor, and liver toxicity; monitor liver function and report signs of jaundice or pain.
- Carbamazepine: modulates sodium channels, can cause dizziness, sedation, bone marrow suppression; monitor CBC, avoid grapefruit juice.
- Lamotrigine: regulates glutamate, used for maintenance; monitor for Steven-Johnson syndrome (serious rash).
- Emphasize blood test monitoring, medication adherence, avoiding abrupt cessation, and side effect management.
Medication Therapy for Schizophrenia
- Schizophrenia features hallucinations, delusions, and disorganized thinking.
- First-generation (conventional) antipsychotics (e.g., chlorpromazine, haloperidol) block dopamine D2 receptors.
- These mainly treat positive symptoms (hallucinations, delusions) but risk extrapyramidal side effects (movement disorders like akathisia, parkinsonism, tardive dyskinesia).
- Neuroleptic malignant syndrome is a rare, life-threatening side effect (signs: fever, rigidity, confusion, unstable BP).
- Second-generation (atypical) antipsychotics (e.g., risperidone, olanzapine) block dopamine and serotonin receptors.
- Atypicals treat both positive and negative symptoms, lower risk of motor side effects, but higher metabolic risk (weight gain, diabetes, hyperlipidemia).
- Clozapine (an atypical) poses a risk for agranulocytosis (dangerously low WBC); requires frequent WBC monitoring.
- Nurses must monitor for side effects, encourage healthy lifestyle changes, and support medication adherence.
Key Terms & Definitions
- Mood Stabilizer — drugs that prevent mood swings in bipolar disorder.
- Lithium Toxicity — potentially dangerous high lithium blood levels causing neurological and cardiac symptoms.
- Extrapyramidal Symptoms — drug-induced movement disorders (tremors, rigidity, involuntary movements).
- Neuroleptic Malignant Syndrome — a life-threatening reaction to antipsychotic drugs with fever and muscle rigidity.
- Agranulocytosis — a severe drop in white blood cells increasing infection risk.
Action Items / Next Steps
- Review medication tables (ATI, Fade Easy, Tucker book Table 22.2 page 387).
- Complete assigned readings on bipolar and schizophrenia medication management.
- Prepare flashcards for drug classes, mechanisms, and key side effects.
- Practice recognizing signs of drug toxicity and patient teaching points.