Focused Review Template 2 (Med. Lithium) PDF

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ACTIVE LEARNING TEMPLATE:

Medication

Heather Morales STUDENT NAME _____________________________________ Lithium (Lithobid) MEDICATION __________________________________________________________________________

REVIEW MODULE CHAPTER ___________

Antimanic Agents CATEGORY CLASS ______________________________________________________________________ PURPOSE OF MEDICATION

Expected Pharmacological Action - Lithium acutely stimulates the NMDA receptor, increasing glutamate availability in the postsynaptic neuron - After chronic administration, lithium induces NMDA downregulation, this way lithium modulates glutamate neurotransmission

Therapeutic Use - Acute mania - Controls acute manic episodes in bipolar disorder (BPD)

Complications - GI effects, (early in treatment, subsiding with time) - Muscle weakness Drowsiness - Headache -Confusion - Polyuria - Tremor (may be a side effect or sign of toxicity) - Goiter and Hypothyroidism - Toxicity due to narrow therapeutic range = Nausea - Muscle Weakness - Fine Tremors progressing to Coarse Tremor - Ataxia - Confusion - Seizures - Coma - Death

Medication Administration - Give with milk or meals to prevent GI effects - Assure that sustained-release tablets are swallowed whole

Contraindications/Precautions - Contraindicated in pt = Pregnancy & Lactation – Teratogenic - Severe renal insufficiency - Moderate / Severe cardiac disorders - Dehydration - Decreased serum sodium -Low-salt diet - History of angioedema caused by ACE inhibitors - Use cautiously in pt. with = Thyroid disorders - Older adults - Seizure disorders - Suicidal ideation - Diabetes Mellitus - Urinary retention

Interactions - NSAIDs (except aspirin), tetracyclines, diuretics, methyldopa, and probenecid increase risk for toxicity - Phenothiazine antipsychotics, such as haloperidol, increase risk for dys-kinesias, urinary retention - Ace inhibitors may increase lithium levels, causing toxicity

Evaluation of Medication Effectiveness - Decreased exaggeration of acute manic episode - Decrease in manic episodes

ACTIVE LEARNING TEMPLATES

Nursing Interventions - Monitor for early, transient adverse effects - Differentiate transient from toxic effects by monitoring lithium levels - Monitor fluid intake and output - Monitor for electrolyte imbalance - Give prescribed beta blocker to decrease tremor - Monitor for increasing tremor - Monitor thyroid function tests yearly - Monitor for signs of hypothyroidism - Monitor serum lithium levels; should be below 1.0 mEq/L - Monitor sodium levels (low sodium can cause toxicity) - Recognize symptoms of toxicity to prevent severe effects - Monitor kidney function during treatment

Client Education - Instruct client to take lithium with food - Advise client notify HCP if effects do not subside or get worse - Instruct client not to drive or perform hazardous tasks if drowsiness occurs - Instruct client to drink 2–3L of fluid/day to prevent dehydration - Advise client to avoid caffeine, stressors, which can increase tremors - Instruct client to notify provider for worsening tremor - Instruct client to report sign of hypothyroidism & neck swelling - Instruct client to recognize signs of toxicity and notify provider - Instruct client to consume adequate amounts of food containing sodium

THERAPEUTIC PROCEDURE

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