let's discuss now the medication therapy for bipolar disorder bipolar disorder is a chronic mental health condition characterized by mood swings between Mania very um High excitement and depression uh treatment focuses on stabilizing the mood fluctuations preventing relapse and improving the quality of life um so medication will play a crucial um role in controlling the symptoms and reducing the severity of those episodes um so what are the medications involved in treatment of bipolar disorder uh first we put the mood will be the mood stabilizers uh in this category we have lithium carbonate that is the first line of treatment uh and is considered absolutely the gold standard for long-term management of this condition um in terms of how it works it modulates dopamine Gaba and now you hear glutamate this is one of the neurotransmitters involved um in the um development of bipolar condition um and by modulating modulating means making it even um to maintain the this medication results in a um mood in maintaining mood stability now what's important to remember about lithium is that it has a very tight therapeutic range between 0.8 and 1.2 mil equivalents per liter uh this is a micro element um therefore is measured in micro M equivalent uh in terms of common side effects that most of the patients may experience them will be nausea um hand tremors uh increased thirst that will lead to poly dipsia poly large or numerous dipsia drinking because they are so thirsty they will drink more than expected and as a result of that they will have frequent urination or polyurea um another common side effect is um the effects of lithium on the thyroid gland that um can lead to hypothyroidism a a low functioning of the thyroid gland um how do we recognize the signs of toxicity this is a very common type of question in your inkx um the early toxicity signs will include muscle weakness confusion and excessive thirst while severe toxicity um will lead to seizures uh coma arhythmia and even death so what do we need to uh discuss with our patients is um that the um lithium levels must be very closely monitored to prevent toxicity while also ensuring that they in the therapeutic range we need to educate our patients on maintaining adequate sodium and fluid intake as dehydration can increase the toxicity risk and let me explain that to you um water um it's a passive element in our body water will follow other elements especially sodium uh so the moment that sodium levels levels are low in the in the body the levels of um fluid in that space of water will be low as well the moment that the levels of sodium are high it will attract water after it in other words in order for lithium to not become toxic my patients cannot be dehydrated so any kind of a question um during your ankx exam that is looking into a patient that has treatment with lithium carbonate that may become dehydrated that can be because of profuse sweating because not having enough intake of fluids because not because of not consuming um enough sodium um or um because of any kind of fluid loss it can be for example diarrhea or uh profused vomiting can lead to dehydration and that can result in lithium toxicity so this is a part of the education sodium it's another key word for you it's always connected uh with ium it's um treatments with lithium is one of the conditions when instead of instructing our our clients to not consume a lot of salt we instruct them to make sure that they consume the um necessary amount of salt of sodium uh to not um get into the situation that they are dehydrated also uh remember to instruct the clients to avoid insides because they can increase the lithium levels leading to toxicity as well because of the effect the nades have have on um the uh kidneys where the elimination of water happens uh a second uh class of medication used in bipolar disease is the anti-seizure medication um they're considered alternative mood stabilizers um those are medications it's a class of medication that we use for those patients that cannot tolerate lithium or need an additional uh mood U stabilizer um they can be an alternative that is pretty effective um Deval proex sodium uh which in other words is valproic acid uh it will enhance Gaba levels and will stabilize the Mood by increasing it Gaba remember that is an inhibitor neurotransmitter that is reducing this excessive neural activity that is seen in patients when they have the manic episodes um so again it can be used for bipolar disorder and seizure control as well and also it's a good uh medication for migraine prevention uh however it has some side effects uh can result in weight gain sedation Tremors and is um um NE it is hepatotoxic can lead to liver dysfunction uh in terms of nursing considerations a patient with um valproic acid treatment will need to monitor their liver function tests um because of this risk of hepatotoxicity and we need to monitor the serum drug levels um and also educate the patient that whenever they can uh they uh they they need to report as soon as possible abdominal pain jice or any signs of liver dysfunction another medication in the same category of um alternative types of medication is carbamazapine that will modulate the sodium channels resulting again in mood stabilizing um uh effects um it will uh be used again in bipolar and trigeminal neuralgia in terms of of side effects we can see dizziness sedation and remember carbamazapine leads to Bone maros supression um that will can lead to um infections um because of that in terms of nursing consideration we'll monitor complete blood count uh because of this risk of developing low levels of white blood cells and anemia we'll need to instruct our patients to report any fever or unusual bruising that's a sign of um bone marrow suppression and avoid grapefruit juice because it will increase the toxicity of carbom mapin um lot Tre Gene that's it's another um U medication in the same class uh it regulates the glutamate um and it produces a long-term mood stability um it it really prevents the mood swings in those kind in this kind of patients and it's used as a maintenance therapy for bipolar disorder in terms of side effects um have dizziness Headache nausea and um a very um extreme type of rash it's called Steven Johnson syndrome that it's a life-threatening type of rash um as nursing consideration we need to monitor for any rash development uh because Steven Johnson syndrome is a medical emergency um and we need to educate them to report any kind of skin changes immediately so um if we need to um kind of summarize U those aspects related to bipolar disease um we need to um educate the patient in um how to monitor serum drug levels uh for lithium and valproic acid we will um instruct them that they require routine blood tests to prevent toxicity levels uh will assess for kidney and liver functions before initiating treatment and throughout therapy um another element that the patient needs to um Ensure is to maintain hydration and sodium intake to prevent lithium toxicity avoid alcohol and any recreational drugs uh because those can actually worsen the mood instability and to encourage medication adherance as sudden discontinuation may increase the risk of a relapse um in terms of managing side effects and uh adherance issues for Sedation we should advise the patient to take medication at night to reduce um this daytime drowsiness uh for nausea we encourage them to take medication with food and for weight gain we encourage them to have a healthy diet and regular uh physical activity so um for summarizing uh elements if you need more information on this uh beside what you find in um fade easy um ATI modules and the ATI Farm book you can uh go to your uh Tucker um book and there is a great summarizing table of most used drugs in um this category um the table is 22.2 on page 387 we will continue Now by discussing medication therapy for schizophrenia um schizophrenia is a chronic mental disorder um that significantly affects person's thoughts emotions and behaviors um it is characterized by hallucination delusions and overall disorganizing thinking um for this Disorder medication plays a critical role in managing both symptoms and preventing relap um so understanding the differences between the two big categories of antipsychotics the first generation and the second one uh first we call it conventional and the second one we call it atypical is essential for both a safe and effective treatment so let's look into the first generation or the conventional anti psychotics um if I have to summarize them in a few words I will say that they are very effective however they have high risks for some side effects examples of this medication will be chlorpromazine and haloperidol and the way that they work is by blocking uh dopamine receptors remember dopamine is one of the neurotransmitters they're bringing us up um and specifically they are blocking the uh D2 receptors and by doing that they are reducing positive symptoms we call positive symptoms um any kind of behaviors that are added on to a normal behavior such as hallucination and delusions um and we call negative symptoms those that we expect a patient to exhibit in a normal behavior but we don't see it um as major side effects um we can look into extra pyramidal symptoms which are movement disorders um they're caused by the fact that dopamine um receptors are blocked in the basil ganglia as well um in terms of what kind of um uh symptoms the patients will show the patients will show athesia which is an inner restlessness or inability to stay still um in um lat term I'll call it the jeters um they can exhibit parkinsonisms it's not a Parkinson disease but it's very similar uh the signs and symptoms that the patients are presenting are very similar to what Parkinson's disease patients have uh and this is muscle rigidity Tremors and the shuffled gate um also they can exhibit tardive discinesia uh which are some involuntary facial movements um as lip smacking tongue protrusion and this is usually irreversible even if we discontinue the medication uh or the patient is doing better um those uh once installed once um present in a in a client um the tar of discinesia will not going to disappear even if we stop the medication um those involuntary facial movements are very similar to ticks um that's one major side effect so this kind of uncontrolled uh movements um and um they're all classified under the extra pyramidal symptoms the second major side effect will be the neuroleptic malignant syndrome which is very rare however life-threatening H and in terms of signs the patients will have high fever severe muscle rigidity confusion unstable blood pressure and an immediate intervention is required um that will start by discontinuing the medication and prevent Pro providing supportive um care so for this first generation antis psychotics in terms of nursing considerations we need to monitor for any type of early signs of extra pyramidal um symptoms and intervene immediately if those um are showing up uh for example we can administer defen hedrin or boping for um um the relief of those symptoms um we need to recognize also quickly any signs of neuroleptic malignant syndrome um and take action as soon as possible to prevent any kind of fatal complication because they can this uh syndrome can result result in death if not recognized and addressed um quickly and also educate the patient on the importance of adherance and um despite the side effects of the medication because um those patients may have a very low compliance so I was telling you that this is the conventional effective but with a lot of side effects and we have the second generation or atypical antis psychotics that have fewer motor side effects however they have higher metabolic risks so no matter how we are looking into medications for schizophrenia there will be some side effects that are important for the patients when we are treating them uh we just need to balance and decide what will be um the less risk for our patients um examples of the atypical antipsychotics will be raridon and olanzapine and they also block dopamine receptors however in the proc process they block The serotonine receptors as well um as a result atypical antis psychotics are both good for positive and negative symptoms um and examples of negative symptoms because I didn't give you before one uh will be social withdrawal lack of motivation things that we want to see in a patient but they do not exhibit so in terms of benefits absolutely no risk for extrapyramidal symptoms um then um they have a lower risk than uh first generation um antis psychotics but they do have risk um from a metabolic point of view so what would be those side effects would be weight gain metabolic syndrome that means an increased risk for diabetes hypertension and Hyper lipidemia drowsiness and sedation um hyperprolactinemia um this is this medication will overstimulate the pituitary gland area that is producing the prolactin um hormone and as a result of that patients will exhibit menstrual irregularities uh gomasa which is an increase in size and shape of um breast uh te issue uh is more evident in male than in female uh and sexual dysfunction um risk of one of them that is called clopine has also the risk of a granulocytosis which requires frequent uh white blood cells uh monitoring because um the white blood cells can be affected so what would be some nursing considerations for that what we should do monitor for weight gain for hypoglycemia and metabolic syndrome as well as encouraging to prevent that encourage a healthy diet regular exercise and lifestyle changes uh to reduce the risk monitor for glucose and lipid levels on a regular uh basis especially in patients that have a pre-existent um diabetes and um educate them on um staying on the treatment to prevent relapse and worsening symptoms um remember if the patient was prescribed clopine this one has a risk for um a granulocytosis so we'll need to ensure regular white blood cells monitoring to detect it so if I need to summarize everything please keep in mind schizophrenia requires lifelong management um and nurses are essential in ensuring that medication is taken safely patients are staying on the treatment uh and educating them on reducing the side effects