8.8 Antimanias
Mood stabilizers are used to treat bipolar affective disorder. Lithium was the first medication used to treat this disorder and is sometimes referred to as an antimania drug because it can help control the mania that occurs in bipolar disorder. Lithium must be closely monitored with a narrow therapeutic range.
Lithium
Mechanism of Action: Lithium alters sodium transport in nerve and muscle cells and affects a shift toward intraneuronal metabolism of catecholamines, but the specific biochemical mechanism of lithium action in mania is unknown.
Indications: Lithium is indicated in the treatment of manic episodes of bipolar disorder and as a maintenance treatment for individuals with a diagnosis of bipolar disorder.
Nursing Considerations: Lithium must be closely monitored with a narrow therapeutic serum range of 0.8 to 1.2 mEq/L. Serum sodium levels should also be monitored for potential hyponatremia.
The drug is contraindicated in renal or cardiovascular disease, severe dehydration or sodium depletion, and to clients receiving diuretics because the risk of lithium toxicity is very high.
Lithium can cause fetal harm in pregnant women. Safety has not been established for children under 12 and is not recommended.
When given to a client experiencing a manic episode, lithium may produce a normalization of symptomatology within 1 to 3 weeks.
Side Effects/Adverse Effects: Fine hand tremor, polyuria, and mild thirst may persist throughout treatment.
Boxed Warning: Lithium toxicity is closely related to serum lithium levels and can occur at doses close to therapeutic levels at 1.5 mEq/L. Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy. Lithium can cause abnormal electrocardiographic (ECG) findings and risk of sudden death. Clients should be advised to seek immediate emergency assistance if they experience fainting, light-headedness, abnormal heartbeats, or shortness of breath.
Signs of early lithium toxicity include diarrhea, vomiting, drowsiness, muscular weakness, and lack of coordination. At higher levels, giddiness, ataxia, blurred vision, tinnitus, and a large output of dilute urine may be seen. No specific antidote for lithium poisoning is known; treatment focuses on the elimination of the medication.
Health Teaching & Health Promotion: Clients should be taught to take medication as directed, get labs drawn as scheduled, and maintain a consistent salt intake. Clients should also be advised that antimanic drugs may increase dizziness and drowsiness and weight gain may occur. Additionally, if individuals have low sodium levels, it may predispose the client to lithium toxicity.[1]
Now let’s take a closer look at the medication grid for lithium in Table 8.8.[2]
Table 8.8 Lithium Medication Grid
| Class/Subclass | Prototype/Generic | Nursing Considerations | Therapeutic Effects | Side/Adverse Effects |
|---|---|---|---|---|
| Antimanic | lithium | Boxed Warning: Monitor for signs