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Flashcards in Ch 9 Deck (20):
1

Lithium carbonate purpose

Mood stabilizer

2

Lithium carbonate adverse effects

GI distress
Fine hand tremors
Polyuria, mild thirst
Weight gain
Renal toxicity
Goiter and hypothyroidism (w/long term)
Bradydysrythmia
Electrolyte imbalance

3

Lithium less than 1.5

Diarrhea
Nausea
Vomiting
Thirst
Polyuria
Muscle weakness
Fine hand tremor
Slurred speech

4

Lithium 1.5-2

Nausea
Vomiting
Diarrhea
Mental confusion
Poor coordination
Coarse tremors

5

Lithium 2-2.5

Extreme polyuria
Blurred vision
Ataxia
Seizures
Severe hypotension
Coma
Death

Intervention: give alert patients emetic
Perform gastric lavage or admin mannitol or aminophylline to increase excretion

6

Lithium greater than 2.5

Rapid progression of symptoms
Coma
Death

Intervention: Hemodialysis

7

Lithium interactions

Reduces serum sodium decrease lithium excretion = toxicity

NSAIDs lead to toxicity

Anticholinergics (antihistamines , tricyclic antidepressants) induce urinary retention and polyuria

8

Nursing admin lithium

Monitor levels 2-3 days then every 2-3 mo

Obtain in morning

12 hrs after last dose

9

Initial treatment lithium level

.8-1.4

10

Maintain lithium level

.4-1

11

Plasma toxicity

>1.5

12

Antiepileptic drugs (AEDs)

Carbamazepine (Tegretol, Equetro)

Valproic acid (Depakote)

Lamotrigine (Lamictal)

13

Carbamazepine adverse effects

CNS effects

Blood dyscrasias (leukopenia, anemia, thrombocytopenia)

Teratogenesis (avoid during preg)

Hypo osmolarity -fluid overload

Skin disorders (dermatitis, rash, Stevens Johnson’s)

14

Lamotrigine

Blurred vision
Dizziness
Headache
Nausea
Vomiting

Stevens Johnson’s

15

Valproic acid adverse effects

GI
Hepatotoxicity
Pancreatitis
Thrombocytopenia
Teratogenesis

16

Carbamazepine interactions

Decrease effects of BC and warfarin

Grapefruit juice inhibits metabolism increasing levels

Phenytoin and phenobarbital decrease effects

17

Lamotrigine interactions

Carbamazepine
Phenytoin
Phenobarbital

> decrease effects


Valproic acids increase half life

18

Valproic acid interactions

Concurrent use increases levels of phenytoin and phenobarbital

19

Lithium carbonate teaching

Increase fluids

Increase sodium

Take with food or milk

*thyroid function assessed periodically

Avoid aerobic activity in hot water (sodium water depletion)

Avoid NSAIDs (take acetaminophen)

Avoid during pregnancy

20

Valproic acid tests

Thrombocyte count

Amylase

Liver function