Mental Hlth - Bipolar

Question 1

Lithium - Class & MOA

Answer 1

• Class: Bipolar Disorder Agent
• MOA: alters Na transport in nerve & muscle cells; balances NE & serotonin in cell membrane
  > follow same distribution pattern in body as water; excreted in kidneys, 80% reabsorbed
  > Narrow therapeutic window: 0.6-1.2 mEq/L
  > Life threatening toxicity > 2.5mEq/L

Question 2

Lithium - Contraindications/Cautions

Answer 2

• Renal disease
• Cardiac disease
• Sodium depletion/altered sodium lvls
• Pregnancy (X)/lactation

Question 3

Lithium - Drug/Drug & AEs

Answer 3

• Drug-Drug:
• Loop diuretics (Furosemide)
• Haloperidol
  > encephalopathic syndrome & irreversible brain damage
• AEs:
  > beginning & transiet: GI effects N/V/D
  > long term: goiter & hypothyroidism
  > others: fine hand tremer, weight gain, mild thirst/dry mouth, hypotension

Question 4

Lithium Toxicity Manifestations

Answer 4

• more severe w/ higher blood lvls
• GI effects: N/V/D
• CNS: lethargy, slurred speech, weakness, tremor, ataxia, clonic movements, hyperreflexia, seizures
• Renal: mild: polyuria; toxicity: Nephrogenic diabetes insipidus
• Cardiac: life-threatening dysrhythmias

Question 5

Lithium Toxicity Interventions

Answer 5

• Hold med
• Gastric lavage or hemodialysis

Question 6

Lithium Nursing Care Plan

assessment

Answer 6

• Neurologic status: LOC, gait, reflexes, tremors
  > monitor S/S toxicity
• Daily: skin turgor, weight, edema

Question 7

Lithium Nursing Care Plan

interventions

Answer 7

• Maintain consistent hydration & sodium intake
  > sodium depletion or dehydration = more reabsorp lithium = toxicity
  > hot weather, diarrhea, other illness
• Fall precautions if CNS effects present
• Teach:
  > drug name, dose, AE (minor vs severe toxicity-ER), blood monitoring
  > therapeutic effects 1-3wks
  > do not operate heavy machinery until lvls are stable
  > contraception as appropriate

Question 8

Lithium Nursing Care Plan

evaluation

Answer 8

• Therapeutic effects
• Labs
  > Serum Litium lvls every 3-6mnths once stable
  > thyroid func yearly
  > kidney func yearly

Question 9

remember this drug is also under antipsychotic considerations