Lithium Flashcards
Lithium
- treats acute mania and maintenance treatment
What is the onset of Lithium duration
- Onset 10 to 21 days → supplemented in the early phases might be needed like: second-generation antipsychotics, anticonvulsants, or antianxiety medications
Is particularly effective in reducing the following:
- Elation, grandiosity, and expansiveness
- Flight of ideas
- Irritability and manipulation
- Anxiety
- Self-injurious behavior
When do you reach therapeutic levels
- Reaching therapeutic levels may take 7-14 days or longer
-What is the target range for lithium serum level(s)
for a 12-hour serum trough level is 0.8–1.2 mEq/L
What is the level for acute mania?
- for acute mania : levels of 1.0–1.2 mEq/L
maintenance phase:levels
- dose 900 to 1200 mg a day
- target serum lithium level 0.6 to 0.8 mEq/L
- 0.4 to 0.6 mEq/L—may be considered in some cases, such as adjunctive treatment for bipolar I patients or monotherapy for bipolar II patients
Blood should be checked every
- 1st lithium level should be drawn every 2 to 3 days after beginning lithium therapy and after any dosage change until the therapeutic level has been reached
- Blood levels check every 3 to 6 months
- Before administering lithium assess:
- renal function and thyroid status
- assess for levels of thyroxine and thyroid-stimulating hormone
- electrocardiogram as needed
- Contraindicated patients with:
- cardiovascular disease
- brain damage
- renal disease
- thyroid disease
- myasthenia gravis
- Whenever possible, not given to women who are pregnant - may harm the fetus.
- Mothers who are breast-feeding
- children younger <12 years
TABLE 13.4 Lithium Side Effects and Signs of Lithium Toxicity
Plasma Level
- less <1.5 mEq/L
Signs
- Nausea
- vomiting
- diarrhea
- thirst
- polyuria (producing too much urine)
- lethargy
- sedation
- fine hand tremor
- Renal toxicity
- goiter (swelling of the neck)
- hypothyroidism with long-term use
Plasma Level
- less <1.5 mEq/L
Interventions
- Symptoms subside during treatment
- Doses should be kept low
- Kidney function and thyroid levels should be assessed before treatment
- Kidney function and thyroid levels annual assessment
- Early Signs of Toxicity
Plasma Level
- 1.5–2.0 mEq/L
Plasma Level
- 1.5–2.0 mEq/L
Signs
- GI upset
- coarse hand tremor
- confusion
- hyperirritability of muscles
- electroencephalographic changes
- sedation
- incoordination
Plasma Level
- 1.5–2.0 mEq/L
Interventions
- Medication should be withheld
- blood lithium levels measured
- dosage reevaluated
- Advanced Signs of Toxicity
Plasma Level - 2.0–2.5 mEq/L
- Advanced Signs of Toxicity
Plasma Level - 2.0–2.5 mEq/L
Signs
- Ataxia (affect co-ordination, balance and speech)
- giddiness (Dizziness)
- serious electroencephalographic changes
- blurred vision
- clonic movements
- large output of dilute urine
- seizures
- stupor
- severe hypotension (low BP)
- coma
- Death is usually secondary to pulmonary complications
Advanced Signs of Toxicity
Plasma Level
- 2.0–2.5 mEq/L
Interventions
- Hospitalization
- The drug is stopped → excretion is hastened → whole bowel irrigation may be done to prevent further absorption of lithium
- Severe Toxicity
Plasma Level
> 2.5 mEq/L
Severe Toxicity
Signs
- Convulsions
- oliguria (producing none or small amounts of urine)
- death can occur
Severe Toxicity
Interventions
Interventions
- Hospitalization
- The drug is stopped → excretion is hastened → whole bowel irrigation may be done to prevent further absorption of lithium
- hemodialysis in severe cases (filter wastes and water from your blood)
- Lithium is a _______ stabilizer
mood
- Lithium is not _______
addictive
- maintain consistent fluid intake how many ML?
1500–3000 mL/day or six 12-oz glasses of fluid
