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Week 3 Medication Paper Psychopharmacology for Advanced Practice Nursing-HFX-DL01 Tashara R Jean

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Medication Paper

Hiromi Chu

Florida National University

Psychopharmacology for Advanced Practice Nursing-DFX-DL01

Dr. Tashara R Jean

January 27, 2024

Lithium is considered a mood stabilizer drug that assists in the treatment of mood disorders. Some of the conditions treated by this drug are mania, hypomania, and frequent episodes of depression. The drug is essential since it helps in the reduction of aggressive or self-harming behaviors. The focus of the paper is

to discuss lithium based on its FDA-approved medication uses, off-label uses, and contraindications of the medications, mechanism of actions, possible side effects, laboratory monitoring or the follow-up processes, and the role of the Psychiatric Mental Health Nurse Practitioner in the prescription and management of the drug. Evidence-Based Treatment Selection (FDA-Approved Uses) The approval of Lithium medicine by the FDA occurred in 1970, and it was purposely

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targeted at the treatment of acute mania. In 1974, as the first and for many years later, it was the only approved medication for the prevention of the recurrence of bipolar disorder (Espejo, 2021). Since then, it has remained the primary use in the United States. Therefore, the medication is indicated for the treatment of manic episodes of bipolar conditions. Off-Label Lithium is prescribed as an adjunct for the treatment of major depressive disorders. It is also used as off-label medication to help in the treatment of bipolar disorder, especially for those lacking a history of mania. The drug is off-label for treating vascular headaches or neutropenia (Pisano et al., 2019). Other uses of the medication include grave illness, agitation, and the syndrome of unsuitable antidiuretic hormone secretion, resulting in abnormal blood sodium levels. This medication is recommended for other conditions only if other drugs fail to work. Contraindications Despite the effectiveness of this medication, some patients are not safe to use this drug. Individuals with renal impairment and those diagnosed with cardiovascular diseases such as hypertension are discouraged from using the drug. The drug leads to reversible changes in the T wave and helps in revealing Brugada syndrome. Before prescribing this medicine, healthcare providers are advised to perform cardiology consultations (Linhart et al., 2020). The approach is recommended for patients who are experiencing unexplained symptoms such as syncope and palpitation. The medicine is also discouraged among children under the age of 12. The medication is also not accepted among pregnant mothers since they are likely to experience a 2 to 3-fold rise in congenital disabilities. Applying this drug during pregnancy exposes the unborn children to the risk of developing Ebstein's anomaly. Therefore, the prescription of this medicine is based on a comparison of the potential benefits to the possible harms of the ongoing application of the drug on pregnant patients (Linhart et al., 2020). When the patient remains on the drug for a long, they have to be monitored every four weeks until they reach 36 weeks, which is followed by weekly monitoring. It is also essential to monitor the

infant regarding the possibility of hypotonia and floppy baby syndrome for at least two days when the mother is on medication during delivery. The mother is discouraged from breastfeeding because traces of the drug can be detected in the breast milk. Mechanism of Action The mechanism of lithium drug is

unknown. Nevertheless, there is rapid absorption and later excretion from the urine. There is no change in the medication until it is excreted, which means there is a lack of metabolism in the medicine. The drug modifies sodium transport in the muscle and nerve cells. It alters neurotransmitters, more so

catecholamine and serotonin (Hedya & Swoboda, 2019). It results in the alteration of intracellular signaling through second messenger systems by preventing the inositol monophosphate. This drug also leads to a drop in the activities of protein kinase C. Consequently, it interferes with the genomic expression linked to the neurotransmission, which causes a rise in the cytoprotective proteins, thus activating neurogenesis and raising the volume of the gray matter. Potential Side Effects Lithium also results in adverse effects, which are dose-associated. One side effect is acute, which affects the cardiovascular system, which involves blockage of the heart, bradycardia, and flattened or inverted T waves. The effect of the drug is also on the central nervous system (CNS), whereby individuals tend to be more confused, lose their memory, and experience slurred speech, ataxia, seizures, coma, and delirium (Ataallah et al., 2020). The drug also affects

renal, and, in this case, nephrogenic diabetes insipidus leads to polyuria and polydipsia. The medication also affects the hematologic system, and this leads to leukocytosis and aplastic anemia. Individuals tend to report a rise in body weight, acne, diarrhea, nausea, and hypothyroidism. Some individuals are also exposed to the risks of developing encephalopathic syndrome, whose symptoms appear to be similar to the neuroleptic malignant syndrome. The Laboratory Monitoring or the Follow-up Various measures are necessary before prescribing the medication to the patients. One of the measures involves the performance of the kidney and thyroid function tests. Patients of age above 50 years must undergo an electrocardiogram to determine the risks in terms of cardiovascular complications.

These tests are repeated once or twice every year for patients on this therapy. Lithium drug is linked with a rise in body weight; therefore, weighing patients

should be the first intervention (Arnett et al., 2019). The other requirement is finding out whether the patient has conditions like pre-diabetes, diabetes, and dyslipidemia. There is also an ongoing process of monitoring the patients for the symptoms of dehydration and dosage reduction when symptoms like diarrhea, infection, and excess weight are reported. The Role of Physicians Mental Health Nurse Practitioner (PMHNP) in the Prescription and Management of the Medicine PMHNP have a vital role in the prescription and the management of lithium drugs. They focus on the signs and symptoms caused by the drug's toxicity and report them to the prescriber and later pharmacists, who assist in changing the dosages and the type of the medication. PMHNP helps maintain coordination with the patients during therapy. It is basically due to the narrow therapeutic index and the potential adverse effects, together with the toxicity of the medication (Chokhawala & Saadabadi, 2023). These professionals engage in consultation with other professionals to assist in effective identification of the need for lithium therapy. The report about the potential side effects illustrates the necessity to monitor lithium levels and the performance of the effective review of a perfectly coordinated interdisciplinary team required to deliver healthcare services.

References

Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., Michos, E.

D., Miedema, M. D., Muñoz, D., Smith, S. C., Virani, S. S., Williams, K. A., Yeboah, J., & Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary prevention of

cardiovascular disease. Circulation, 140(11), e596–e646. https://doi.org/10.1161/cir.0000000000000678

Ataallah, B., Al-Zakhari, R., Sharma, A., Tofano, M., & Haggerty, G. (2020). A Rare but Reversible Cause of Lithium-Induced Bradycardia. Cureus, 12(6).

https://doi.org/10.7759/cureus.8600

Chokhawala, K., & Saadabadi, A. (2023, February 26). Lithium. PubMed. https://www.ncbi.nlm.nih.gov/books/NBK519062/ Hedya, S. A., & Swoboda, H.

D. (2019). Lithium Toxicity. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499992/ Linhart, A., Germain, D. P., Olivotto, I., Akhtar,

M. M., Anastasakis, A., Hughes, D., Namdar, M., Pieroni, M., Hagège, A., Cecchi, F., Gimeno, J. R., Limongelli, G., & Elliott, P. (2020). An expert consensus document on the management of cardiovascular manifestations of Fabry disease. European Journal of Heart Failure, 22(7), 1076–1096.

https://doi.org/10.1002/ejhf.1960

Pisano, S., Pozzi, M., Catone, G., Scrinzi, G., Clementi, E., Coppola, G., Milone, A., Bravaccio, C., Santosh, P., & Masi, G. (2019). Putative Mechanisms of

Action and Clinical Use of Lithium in Children and Adolescents: A Critical Review. Current Neuropharmacology, 17(4), 318–341.

https://doi.org/10.2174/1570159X16666171219142120

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https://www.statpearls.com/kb/viewarticle/24349 70 %

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Submitted paper

Florida National University

Original source

Florida National University

Submitted paper

Psychopharmacology for Advanced Practice Nursing-DFX-DL01

Original source

Psychopharmacology for Advanced Practice Nursing-DFX-DL01

Submitted paper

The focus of the paper is to discuss lithium based on its FDA-approved medication uses, off-label uses, and contraindications of the medications, mechanism of actions, possible side effects, laboratory monitoring or the follow-up processes, and the role of the Psychiatric Mental Health Nurse Practitioner in the prescription and management of the drug.

Original source

This paper will discuss its FDA-approved uses, off-label uses, contraindications, mechanism of action, potential side effects, lab monitoring/follow-up, and the role of Psychiatric Mental Health Nurse Practitioners (PMHNPs) in prescribing and managing the medication

Submitted paper

It is also essential to monitor the infant regarding the possibility of hypotonia and floppy baby syndrome for at least two days when the mother is on medication during delivery.

Original source

If a mother receives lithium during delivery, it is essential to monitor the infant for hypotonia and floppy baby syndrome for at least 48 hours

Submitted paper

Mechanism of Action The mechanism of lithium drug is unknown.

Original source

Mechanism of Action The mechanism of action of lithium is not known

Submitted paper

The drug modifies sodium transport in the muscle and nerve cells.

Original source

Lithium modifies sodium transport in nerve and muscle cells

Submitted paper

The drug also affects renal, and, in this case, nephrogenic diabetes insipidus leads to polyuria and polydipsia.

Original source

Nephrogenic diabetes insipidus with polyuria and polydipsia

Submitted paper

These tests are repeated once or twice every year for patients on this therapy.

Original source

Repeat these tests once or twice a year in patients on lithium therapy

https://www.statpearls.com/kb/viewarticle/24349

Student paper 100 %

Student paper 75 %

Student paper 84 %

Student paper 77 %

Student paper 84 %

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K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z.

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K., Blumenthal, R S., Albert, M A., Buroker, A B., Goldberger, Z

Submitted paper

D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., Michos, E.

Original source

D., Hahn, E J., Himmelfarb, C D., Khera, A., Lloyd-Jones, D., McEvoy, J W., Michos, E

Submitted paper

D., Miedema, M. D., Muñoz, D., Smith, S. C., Virani, S. S., Williams, K.

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D., Miedema, M D., Muñoz, D., Smith, S C., Virani, S S., Williams, K

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A., Yeboah, J., & Ziaeian, B.

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A., Yeboah, J., & Ziaeian, B

Submitted paper

2019 ACC/AHA guideline on the primary prevention of cardiovascular disease.

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2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

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Circulation, 140(11), e596–e646. https://doi.org/10.1161/cir.0000000000000678

Original source

Circulation, 140(11) https://doi.org/10.1161/cir.0000000000000678 Centers for Disease Control and Prevention

Submitted paper

Cureus, 12(6). https://doi.org/10.7759/cureus.8600

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Cureus, 12(6), e8407 https://doi.org/10.7759/cureus.8407

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Chokhawala, K., & Saadabadi, A.

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K., & Saadabadi, A

Submitted paper

https://www.ncbi.nlm.nih.gov/books/NBK519062/ Hedya, S.

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https://www.ncbi.nlm.nih.gov/books/

Student paper 76 %

ProQuest document 71 %

Student paper 100 %

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https://www.ncbi.nlm.nih.gov/books/NBK499992/ Linhart, A., Germain, D.

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https://www.ncbi.nlm.nih.gov/books/

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https://doi.org/10.1002/ejhf.1960

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https://doi.org/10

Submitted paper

Pisano, S., Pozzi, M., Catone, G., Scrinzi, G., Clementi, E., Coppola, G., Milone, A., Bravaccio, C., Santosh, P., & Masi, G.

Original source

Pisano, S., Pozzi, M., Catone, G., Scrinzi, G., Clementi, E., Coppola, G., Milone, A., Bravaccio, C., Santosh, P., & Masi, G

Submitted paper

Putative Mechanisms of Action and Clinical Use of Lithium in Children and Adolescents: A Critical Review. Current Neuropharmacology, 17(4), 318– 341.

Original source

Putative mechanisms of action and clinical use of lithium in children and adolescents A critical review Current Neuropharmacology, 17(4), 318-341

Submitted paper

https://doi.org/10.2174/1570159X16666171219142120

Original source

https://doi.org/10.2174/1570159X16666171219142120