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Pharm 3

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  • Hello Ms. Smith, I have your new prescription for Lithium to help you manage your manic depression. Before you leave, I need to provide you with some information about the drug.
  • You need to take it at the same time everyday and not double the dose if you miss one. Lithium works by altering sodium ion transport in your nerves and can cause side effects such as fatigue, headache, muscle weakness, and tremors. 
  • Ok, what do I need to know?
  • Also, it's important for you to drink plenty of water and not caffeinated drinks. Don't take diuretic medications or NSAIDs like Aspirin either because they may change the amount of lithium in your body. Too much lithium is toxic and too little won't be therapeutic for you.
  • Ok, I'll take the medication first thing every morning but how will I know if there is too much or too little in my body?
  • We'll test your blood to make sure it's within limits in 5 days and then run tests every 6 months. If you experience vomiting, persistent headache, or confusion, call your doctor or go the ER as soon as you can. Here's a pamphlet that has additional information. As always, you can call your HCP if you have any concerns.
  • That's excellent, thank you! I'll definitely read through the pamphlet and contact you if I have questions! I'll make sure to come in in 5 days to test my lithium levels and I'll make sure to drink water regularly and not change my diet drastically.
  • Pharmacologic Action: Lithium action is not completely known but research as shown it may work on sodium ions in nerve cells. Thereby, this shifts the metabolism of catecholamine. (Lilley, p. 255, 2017) Common Side Effects: Drowsiness, headache, slurred speech, epilepsy-like seizures, choreoathetotic movement (wave-like movements), ataxia, and hypotension. (Lilley, p. 256, 2017) Other acute, mild side effects include fasciculation, nausea, diarrhea, polyuria, polydipsia, and weight gain. (Coryell, 2018)
  • References Coryell, W. (2018, May). Drug Treatment of Bipolar Disorder. In Merck Manual. Retrieved October 27, 2018, from https://www.merckmanuals.com/professional/psychiatric-disorders/mood-disorders/drug-treatment-of-bipolar-disorder Lilley, L., Collins, S., & Snyder, J. (2018). Pharmacology and the Nursing Process (8th ed., pp. 255-256). St. Louis, MO: Elsevier.
  • Client Teaching: It is very important for the client to have proper hydration but avoid overhydration and dehydration. Drinking caffeinated drinks can cause frequent urination which can alter the amount of lithium in the system and should be avoided. Any sort of renal impairment can also increase lithium levels and is contraindicated for these patients. The client should also not drastically change their dietary intake of sodium. (Lilley, p. 256, 2017)  Interactions: Lithium should not be combined with thiazide diuretics, ACE inhibitors and NSAIDs which can cause hyperlithemia. (Coryell, 2018)
  • Therapeutic Range: Steady levels of 0.8-1.2 mEq/L is needed. Above 1.5 mEq/L is toxic and should be corrected as soon as possible. (Coryell, 2018) Serum Lithium Testing: Should be performed 5 days after being started and 12 hours after the last dose. Once stable levels are established, serum lithium levels should be checked every 6 months or whenever dose has been changed. (Coryell, 2018) Adverse effects: Gross tremor, increased deep tendon reflexes, persistent headache, vomiting, and confusion progressing to stupor, seizures, and cardia arrhythmias are signs of acute lithium toxicity. This is most commonly found in elderly patients, patients with decreased creatinine clearance, and those with sodium loss. (Coryell, 2018)
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