Transcript Lithium carbonate or Eskaltih

Lithium
By: Stephanie Halbleib
Goal
To impart critical information about
lithium to a target audience of first
year nursing students.
Objectives
At the end of presentation participants will be able to:
Describe what lithium is used for and how it works.
Identify 5 side effects of lithium.
Verbalize 3 contraindications related to lithium.
Describe 2 nursing considerations for lithium.
Content
Outline
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Generic and Brand Names
Indications
Actions
Pharmacokinetics
Dosage and Routes
Side Effects
Contraindications/Precautions
Nursing Considerations
Patient Teaching
Summary
Questions and Answers
Brand Name:
Lithobid, Eskalith,
Lithonate, Lithotabs,
Cibalith-S (syrup)
Therapeutic Class:
Antimanic/mood stabilizer
Chemical Class:
Alkaline metal
Generic Name:
lithium carbonate,
lithium citrate (syrup)
Pregnancy Category:
D
Indication
Lithium is used to treat manic depressive disorder also called
bipolar disorder. It works to stabilize the mood and reduce
extremes in behavior by restoring the balance of certain
natural substances in the brain.
Action
The exact mechanism of action is unknown, but lithium
alters neuronal sodium transport.
May alter sodium, potassium ion transport across cell
membrane in nerve, muscle cells.
May also balance biogenic amines of
norepinephrine, serotonin in CNS areas involved
in emotional responses.
Action of Lithium
Onset: rapid
Peak: ½-12hours
Duration: days
Half life: 18-36 hours
1-3 weeks to reach
steady state
Pharmacokinetics
Route: PO
Tablet, Capsule,
Extended-release
table, Solution/syrup
Therapeutic level:
0.4 -1mEq/L
Steady state:
5 - 7 days
Pharmacokinetics
 Absorption: Readily absorbed from the gastrointestinal tract and liver, with
complete absorption occurring after about 8 hours. Absorption is not significantly
impaired by food.
 Distribution: Lithium does not bind to protein. 80% of lithium is filtered and
reabsorbed by the renal tubules. Distribution across the blood-brain barrier is slow;
however, the cerebrospinal fluid lithium level is about 40% of the plasma
concentration. Lithium is able to cross the placenta and is excreted in breast milk.
 Elimination: About 95% of lithium is eliminated by the kidney, entirely unchanged.
Therefore, poor renal function impairs the excretion of lithium. Elimination can
also be detected in sweat and saliva.
 Special Populations for the Elderly: Decreases rate of excretion; increases
incidence of toxic effects. Therefore, lower doses and more frequent monitoring
are recommended.
Dosage and Route
Capsules, Tablets Adults and children age 12 and older:
 Initial: 300-600mg t.i.d.
 Maintenance: 300mg t.i.d. q.i.d.
 Maximum: 2,400g daily
E.R. Tablets Adults and children age 12 and older:
 Initial: 900-1,800mg daily divided does b.i.d. or t.i.d.
 Maintenance: 450mg b.i.d. or 300mg t.i.d.
 Maximum: 2,400g daily
Syrup Adults and children age 12 and older:
 Initial: 8-16mEq (300-600mg) t.i.d.
 Maintenance: 8mEq (300mg) t.i.d or q.i.d.
 Maximum: Equivalent of 2,400g daily
Children up to age 12:
 0.4-0.5 mEq (15-20mg) per kg daily divided doses b.i.d. or t.i.d.
Side Effects
Lithium may cause:
Sever symptoms:

Restlessness


Difficult control of fine
hand movements
Change in the taste
food

Swollen lips

Loss of appetite

Acne

Stomach pain or
bloating

Hair loss

Discomfort to cold
temperatures

Gas

Indigestion

Constipation

Weight gain or loss

Depression

Dry mouth

Joint or muscle pain

Excessive saliva


Tongue pain
Thin, brittle fingernails or
hair
Swelling of the eyes,

face, lips, tongue, throat,
hands, feet, ankles, or

lower legs

Shaking or movements
that you cannot control

Muscle weakness,
stiffness, twitching, or

tightness
Confusion and/or
hallucinations

Slow, jerky movements

Frequent urination

Blackouts or seizures

Ringing in the ears

Irregular, or pounding
heartbeat or chest
tightness

Itching, rash

Diarrhea or vomiting



Slurred speech
Painful or discolored
fingers and toes
Headache
Changes in vision or
crossed eyes
Contraindications
Precautions
 Hypersensitivity
 Any degree of cardiac, renal, or thyroid
disease
 Severe cardiovascular or renal disease
 Dehydrated or debilitated patients
 Brugada syndrome
 Bone marrow depression
 Myeloproliferative
 Brain damage, or coma
 Sever hypertension or hypotension
 Alcohol use
 Pregnant or lactating patients
 Diabetes mellitus
 Fetal cardiac anomalies are associated with
lithium use; however, potential maternal
benefit may warrant use in some pregnant
women
 Initial dosage should be decreased in the
elderly
 Lithium can cause side effects that may
impair your thinking or reactions. Be careful
if you drive or do anything that requires you
to be awake and alert.
Nursing Considerations
Assessment:
 Assess mental status (orientation, mood, behavior) initially and periodically. Initiate suicide precautions if indicated.
 Monitor intake and output ratios. Report significant changes in totals. Unless contraindicated, fluid intake of at
least 2,000-3,000mL/day. Weight should also be monitored at least every 3 months.
 Palpate thyroid gland to detect enlargement because drug may cause goiter.
Lab test considerations:
 Evaluate renal and thyroid function, EGCs, WBC with differential, serum electrolytes, and glucose periodically
during therapy.
Toxicity and overdose:
 Monitor serum lithium levels twice weekly during initiation of therapy and every 2 months during chronic therapy.
Draw blood samples in the morning immediately before next dose. Therapeutic levels range from 0.5-1.5mEq/L for
acute mania and 0.6-1.2mEq/L for long term control. Serum concentration should not exceed 2.0mEq/L.
 Assess patient for symptoms of lithium toxicity (see next slide). If these occur, report before administering next dose.
Implementation:
 Do not confuse lithium carbonate with lanthanum carbonate. Note that 5mL of lithium citrate equals 8mEq of
lithium ion or 300mg of lithium carbonate.
 Administer with food or milk to minimize GI irritation. Extended-release preparations should be swallowed whole; do
not break, crush, or chew. Dilute syrup with juice or other flavored drink before administering.
Nursing Consideration for Toxicity
Therapeutic level: 0.5-1.0 mEq/L
 Early indications: Less than1.5mEq/L
 Diarrhea, nausea, vomiting, thirst, polyuria, muscle
weakness, fine hand tremor, slurred speech.
 Advise clients to withhold medication and notify
the provider.
 Advanced indications: 1.5 to 2.0 mEq/L
 Ongoing gastrointestinal distress, including
nausea, vomiting, and diarrhea; mental
confusion; poor coordination; coarse tremors.
 Advise clients to withhold medication and notify
the provider. Administer new dosage based on
serum lithium levels.
 If manifestations are severe, it may be necessary
to promote excretion.
 Severe toxicity: 2.0 to 2.5 mEq/L
 Extreme polyuria of dilute urine, tinnitus, blurred
vision, ataxia, seizures, severe hypotension
leading to coma and possibly death from
respiratory complications
 Give alert clients an emetic.
 Perform gastric lavage or administer urea,
mannitol, or aminophylline to increase the rate
of excretion.
 Greater than: 2.5mEq/L
 Rapid progression of symptoms leading to coma
and death.
 Hemodialysis.
Patient Teaching
 Inform the patient that frequent urination, nausea, and thirst may occur during the first few days of
treatment.
 Instruct patient to report signs of toxicity, such as diarrhea, drowsiness, muscle weakness, tremor,
uncoordinated body movements, and vomiting.
 Low sodium levels may predispose patient to toxicity. Advise patient to drink 2,000-3,000mL fluid
each day and eat a diet with consistent and moderate sodium intake. Excessive amounts of
coffee, tea, and cola should be avoided because of diuretic effects. Avoid activities that cause
excess sodium loss (heavy exertion, exercise in hot weather, saunas).
 Advise the patient that weight gain may occur. Review principles of low-calories diet.
 Instruct patient to take medication as directed, even if feeling well. Take missed doses as soon as
remembered unless within 2 hours of next dose, or 6 hours if extended-release.
 Advise patient to use contraception and to consult health care professional if pregnancy is
suspected or if breastfeeding.
 Lithium may cause dizziness or drowsiness. Caution patient to avoid driving or other activities
requiring alertness until response to medication is known.
 Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal
products being taken or changes.
 Lithium is used to treat and prevent episodes of mania
that occur in bipolar disorder.
Summary
 Lithium is in a class of medications called anitmanic
agents.
 It is not known how lithium works to stabilize a person’s
mood. However, it is known that lithium does not act on
the central nervous system.
 Comes as tablet, capsule, extended-release (ER) tablet,
and syrup to be taken by mouth. Tablets, capsules, and
syrup are usually taken 3-4 times a day. ER tablets are
usually taken 2-3 times a day.
 It is important for your patients to follow a proper diet,
including the right amounts of fluid and salt during your
treatment.
 There are many side effects that can occur while on
lithium. Make sure your patient understands to call their
doctor if they are experience any unusual symptoms.
 Toxicity is can occur, therefore patients should know the
early signs (diarrhea, nausea, vomiting, thirst, polyuria,
muscle weakness, fine hand tremor, slurred speech).
1. What is 1 brand name of lithium?
Questions
2. What is the indications or therapeutic uses
lithium?
3. What is the action of lithium?
4. Name 5 possible side effects related to lithium?
5. Name 3 contradictions related to lithium?
6. Name 2 nursing consideration for lithium?
7. What is the therapeutic level of lithium?
8. What are some potential nursing diagnoses for a
patient taking lithium?
9. What are some desired outcomes for patients
taking lithium?
10.Name 1 other fact that you learned about
lithium?
Answers
1. Lithobid, Eskalith, Lithonate, Lithotabs, Cibalith-S (syrup).
2. The indications of use for lithium is to treat recurrent
bipolar affective disorder, and to prevent bipolar disorder
depression.
3. The exact mechanism of action is unknown, but lithium
alters neuronal sodium transport.
4. Side effects see slide 10.
5. Contradictions see slide 11.
6. Nursing considerations see slides 12 and 13.
7. Therapeutic level is 0.5 to 1.0 mEq/L.
8. Disturbed thought process, ineffective coping,
imbalanced nutrition: risk for more than body
requirements.
9. Resolution of the symptoms of mania (hyperactivity,
pressured speech, poor judgment, need for little sleep).
Decreased incidence of mood swings in bipolar disorders.
Improved affect in unipolar disorders. (Improvement in
condition may require 1-3 weeks). Remission of depressive
symptoms.
10. Answers will vary with every student.
References
 Deglin, J. H., & Vallerand, A. H. (2009). Davis's drug guide for nurses (11th ed.).
Philadelphia, Penn.: F.A. Davis.
 Karch, A. M. (2004). 2004 Lippincott's nursing drug guide. Philadelphia: Lippincott Williams
& Wilkens. Retrieved March 4,2014, from web.squ.edu.om/medLib/MED_CD/E_CDs/Psychiatric Nursing Care Plans/monographs/thioridazine
hydrochloride.htm
 Sullivan, K. (2010). 2010 nurse's drug handbook (9th ed.). Boston: Jones and Bartlett.
 Videbeck, S. L. (2011). Psychiatric-mental health nursing (5th ed.). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.