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Mood DisordersPsychiatric Nursing: Contemporary Practice

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What is the usual dosage range of Divalproex sodium/Depakote?
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15-60 mg/kg
What is the usual dosage range of carbamazepine/Tegretol?
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200-1200 mg
You have a patient that is on Lithium. During your assessment you notice a fine hand tremor when the patient reaches out for the medication. After questioning, you ascertain the patient has a metallic taste in her mouth, is really thirsty, has had diarr
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These are normal side effects of Lithium
You have a patient that is on Lithium. During your assessment you notice the patient has muscle twitches and is vomiting. After further assessment you determine the patient is experiencing tinnitus, dizziness, ataxia and severe diarrhea. What are your
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The patient has signs and symptoms of moderate lithium toxicity.
You have a patient that is on Lithium. During your assessment you note coarse tremors, nystagmus and muscle fasciculations. What are your findings?
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The patient has signs and symptoms of severe lithium toxicity.
What blood tests should be obtained before starting divalproex sodium/Depakote therapy?
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Baseline liver function tests and CBC with platelets.
What is the boxed warning for divalproex sodium/Depakote?
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It is hepatotoxic and has an increased risk of birth defects.
What are the optimal blood levels for Depakote?
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50-150 ng/mL (80)
How often should blood levels of Depakote be monitored?
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Weekly until the patient is stable, then once every 6 months
Who should not be prescribed divalproex sodium/Depakote?
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Patients with liver dysfunction or those who develop pancreatitis while on the medication.
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What class of drug is Carbamazepine/Tegretol?
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Anticonvulsant
What are common side effects of carbamazepine/Tegretol?
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Dizziness, drowsiness, n/v (can be avoided with slow, incremental dosing), clinical unimportant decreases in WBC, and mild nonprogressive elevations of liver function tests.
What is the boxed warning for carbamazepine/Tegretol?
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It can cause aplastic anemia and agranulocytosis
What conditions should a nurse monitor for if a patient is on carbamazepine/Tegretol?
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Blood dyscrasias and liver damage, baselines values should be taken and then reassessed at 1 months, 3 months, 6 months and then yearly.
What yearly tests should a patient on carbamazepine/Tegretol have done?
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Liver function tests, CBC, electrolyte levels, BUN, thyroid function tests, urinalysis and eye exams.
During the acute phase of treatment with carbamazepine/Tegretol, how often should serum levels be drawn?
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Monthly until the patient is on a stable dosage (level is 8-12 ng/mL)
What interventions can help a patient with edema of the hands/feet from Lithium?
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Monitor I&O, monitor sodium intake, elevate legs when sitting or lying.
What interventions can help a patient with hand tremors from Lithium?
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Minimize stressors (tremors get worse with stress), notify HCP, suggest more frequent, smaller doses of lithium.
What interventions can help a patient with muscle weakness, fatigue or memory and concentration difficulties from lithium?
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Provide support & reassurance, these symptoms usually pass after a few weeks. Provide ST memory aids like lists or phone calls, notify HCP if it impacts patient's compliance
What are signs and symptoms of toxicity from valproate/Depakote or carbanazepine/Tegretol?
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Dizziness, stupor, agitation, disorientation, nystagmus, urinary retention, n/v, tachycardia, hypotension or HTN, cardiovascular shock, coma and respiratory depression.
What is the boxed warning for Lamotrigine/Lamictal?
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Skin rash, which can be a sign of Stephens Johnson syndrome
  
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