{"id":358,"date":"2019-11-19T16:58:42","date_gmt":"2019-11-19T16:58:42","guid":{"rendered":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/8-8-antimania\/"},"modified":"2025-01-16T22:29:15","modified_gmt":"2025-01-16T22:29:15","slug":"8-8-antimania","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/8-8-antimania\/","title":{"raw":"8.8 Antimanias","rendered":"8.8 Antimanias"},"content":{"raw":"
\n\nMood 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.\n

Lithium<\/h2>\nMechanism of Action: <\/strong>Lithium alters sodium transport in [pb_glossary id=\"653\"]nerve[\/pb_glossary]<\/b> and muscle cells and affects a shift toward intraneuronal metabolism of catecholamines, but the specific biochemical mechanism of lithium action in mania is unknown.\n\nIndications: <\/strong>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.\n\nNursing Considerations: <\/strong>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.\n\nThe 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.\n\nLithium can cause fetal harm in pregnant women. Safety has not been established for children under 12 and is not recommended.\n\nWhen given to a client experiencing a manic episode, lithium may produce a normalization of symptomatology within 1 to 3 weeks.\n\nSide Effects\/Adverse Effects: <\/strong>Fine hand tremor, polyuria, and mild thirst may persist throughout treatment.\n\nBoxed Warning:<\/strong> 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.\n\nSigns 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.\n\nHealth Teaching & Health Promotion: <\/strong>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.[footnote]This work is a derivative of DailyMed<\/a> by U.S. National Library of Medicine<\/a> in the Public Domain<\/a>. [\/footnote]<\/sup>\n\nNow let's take a closer look at the medication grid for lithium in Table 8.8.[footnote]This work is a derivative of\u00a0DailyMed<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a> in the\u00a0Public Domain<\/a>. [\/footnote]<\/sup>\n\nTable 8.8 Lithium Medication Grid\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/Generic<\/strong><\/th>\nNursing <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Antimanic<\/strong><\/th>\nlithium<\/a><\/td>\nBoxed Warning: Monitor for signs of lithium toxicity\n\nMonitor serum lithium and sodium levels\n\nContraindicated in renal and cardiovascular disease and in dehydration<\/td>\nWhen given during a manic episode, symptoms may resolve in 1-3 weeks\n\nWhen given for maintenance therapy, it should reduce the frequency and intensity of manic episodes<\/td>\nLithium toxicity\n\nHyponatremia\n\nTremor\n\nCardiac arrhythmia\n\nPolyuria\n\nThirst<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
\n
\n

Critical Thinking Activity 8.8\"Image<\/h2>\n<\/header>\n
\n\nA 42-year-old male was recently diagnosed with bipolar disorder after his partner became concerned about his extreme highs and lows in moods. His high mood swings were often associated with grandiose ideas, gambling, risky sexual behavior, and shopping sprees that were causing the couple to go bankrupt. The provider prescribed lithium.\n
    \n
  1. The client states, \u201cThe doctor told me I am having manic episodes. What does that mean?\u201d What is the nurse\u2019s best response?<\/li>\n\n
  2. The nurse knows that there is a risk of lithium toxicity. What are the symptoms of lithium toxicity, and how will it be prevented?<\/li>\n\n
  3. The client\u2019s partner asks, \u201cHow quickly will the lithium work?\u201d What is the nurse\u2019s best response?<\/li>\n<\/ol>\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key<\/a>\" section at the end of the book.\n\n<\/div>\n<\/div>\n<\/div>","rendered":"
    \n

    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.<\/p>\n

    Lithium<\/h2>\n

    Mechanism of Action: <\/strong>Lithium alters sodium transport in nerve<\/a><\/b> and muscle cells and affects a shift toward intraneuronal metabolism of catecholamines, but the specific biochemical mechanism of lithium action in mania is unknown.<\/p>\n

    Indications: <\/strong>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.<\/p>\n

    Nursing Considerations: <\/strong>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.<\/p>\n

    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.<\/p>\n

    Lithium can cause fetal harm in pregnant women. Safety has not been established for children under 12 and is not recommended.<\/p>\n

    When given to a client experiencing a manic episode, lithium may produce a normalization of symptomatology within 1 to 3 weeks.<\/p>\n

    Side Effects\/Adverse Effects: <\/strong>Fine hand tremor, polyuria, and mild thirst may persist throughout treatment.<\/p>\n

    Boxed Warning:<\/strong> 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.<\/p>\n

    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.<\/p>\n

    Health Teaching & Health Promotion: <\/strong>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]<\/sup><\/a><\/sup><\/p>\n

    Now let’s take a closer look at the medication grid for lithium in Table 8.8.[2]<\/sup><\/a><\/sup><\/p>\n

    Table 8.8 Lithium Medication Grid<\/p>\n\n\n\n\n
    Class\/Subclass<\/strong><\/th>\nPrototype\/Generic<\/strong><\/th>\nNursing <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
    Antimanic<\/strong><\/th>\nlithium<\/a><\/td>\nBoxed Warning: Monitor for signs of lithium toxicity<\/p>\n

    Monitor serum lithium and sodium levels<\/p>\n

    Contraindicated in renal and cardiovascular disease and in dehydration<\/td>\n

    		When given during a manic episode, symptoms may resolve in 1-3 weeks<\/p>\n

    When given for maintenance therapy, it should reduce the frequency and intensity of manic episodes<\/td>\n

    		Lithium toxicity<\/p>\n

    Hyponatremia<\/p>\n

    Tremor<\/p>\n

    Cardiac arrhythmia<\/p>\n

    Polyuria<\/p>\n

    Thirst<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

    \n
    \n
    \n

    Critical Thinking Activity 8.8\"Image<\/h2>\n<\/header>\n
    \n

    A 42-year-old male was recently diagnosed with bipolar disorder after his partner became concerned about his extreme highs and lows in moods. His high mood swings were often associated with grandiose ideas, gambling, risky sexual behavior, and shopping sprees that were causing the couple to go bankrupt. The provider prescribed lithium.<\/p>\n

      \n
    1. The client states, \u201cThe doctor told me I am having manic episodes. What does that mean?\u201d What is the nurse\u2019s best response?<\/li>\n
    2. The nurse knows that there is a risk of lithium toxicity. What are the symptoms of lithium toxicity, and how will it be prevented?<\/li>\n
    3. The client\u2019s partner asks, \u201cHow quickly will the lithium work?\u201d What is the nurse\u2019s best response?<\/li>\n<\/ol>\n

      Note: Answers to the Critical Thinking activities can be found in the “Answer Key<\/a>” section at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

      1. This work is a derivative of DailyMed<\/a> by U.S. National Library of Medicine<\/a> in the Public Domain<\/a>. ↵<\/a><\/li>
      2. This work is a derivative of\u00a0DailyMed<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a> in the\u00a0Public Domain<\/a>. ↵<\/a><\/li><\/ol><\/div>
        definition<\/span>