Lithium Drug Study

In making a Drug Study, the following elements must be present: Generic Name and the Brand name (not all brands, just the brand used by the patient), Action, Indication, Pregnancy Category, Drug Classification, and Contraindication, Adverse Effect, Drug interaction and Nursing Consideration/Intervention…. Most clinical instructors preferred this to be in a long bond paper in printed or handwritten with paper in landscape.

Lithium

Brand Name: lithium carbonate, Carbolith (CAN), Duralith (CAN), Eskalith, Eskalith CR, Lithizine (CAN), Lithobid, Lithonate, Lithotabs, PMS-Lithium Carbonate (CAN)

Pregnancy Category D

Drug class: Antimanic agent

Therapeutic actions

Mechanism is not known; alters sodium transport in nerve and muscle cells; inhibits release of norepinephrine and dopamine, but not serotonin, from stimulated neurons; slightly increases intraneuronal stores of catecholamines; decreases intraneuronal content of second messengers and may thereby selectively modulate the responsiveness of hyperactive neurons that might contribute to the manic state.

Indications

· Treatment of manic episodes of manic-depressive illness; maintenance therapy to prevent or diminish frequency and intensity of subsequent manic episodes

· Unlabeled use: improvement of neutrophil counts in patients with cancer chemotherapy–induced neutropenia and in children with chronic neutropenia and HIV patients on zidovudine therapy (doses of 300–1,000 mg/day, serum levels of 0.5 and 1 mEq/L); prophylaxis of cluster headache and cyclic migraine headache, treatment of SIADH, hypothyroidism (doses of 600–900 mg/day)

Contraindications

· Contraindicated with hypersensitivity to tartrazine; significant renal or CV disease; severe debilitation, dehydration; sodium depletion, patients on diuretics (lithium decreases sodium reabsorption, and hyponatremia increases lithium retention); pregnancy; lactation.

Adverse effects

Polyuria, Coarse hand tremor, mental confusion, hyperirritability of muscles, drowsiness, incoordination, ECG changes, Persistent GI upset, gastritis, salivary gland swelling, abdominal pain, excessive salivation, flatulence, indigestion, Ataxia, giddiness, fasciculations, tinnitus, blurred vision, clonic movements, seizures, stupor, coma

Drug Interactions:

· Increased risk of toxicity with thiazide diuretics due to decreased renal clearance of lithium--reduced lithium dosage may be necessary

· Increased plasma lithium levels with indomethacin and some other NSAIDs--phenylbutazone, piroxicam, ibuprofen, as well as fluoxetine and methyldopa

· Increased CNS toxicity with carbamazepine

· Encephalopathic syndrome (weakness, lethargy, fever, tremulousness, confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes) with irreversible brain damage when taken with haloperidol

· Greater risk of hypothyroidism with iodide salts

· Decreased effectiveness due to increased excretion of lithium with urinary alkalinizers, including antacids, tromethamine

Nursing considerations

· Give with caution and daily monitoring of serum lithium levels to patients with renal or CV disease, debilitation, or dehydration or life-threatening psychiatric disorders.

· Give drug with food or milk or after meals.

· Monitor clinical status closely, especially during initial stages of therapy; monitor for therapeutic serum levels of 0.6–1.2 mEq/L.

· Individuals vary in their reponse to this drug; some patients may exhibit toxic signs at serum lithium levels considered within the therapeutic range.

· Advise patient that this drug may cause serious fetal harm and cannot be used during pregnancy; urge use of barrier contraceptives.

· Decrease dosage after the acute manic episode is controlled; lithium tolerance is greater during the acute manic phase and decreases when manic symptoms subside.

· Ensure that patient maintains adequate intake of salt and adequate intake of fluid (2,500–3,000 mL/day).