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SafeAssign Originality Report • Submitted on Sun, Jan 28, 2024, 6:01 PM

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

Total Score: 37 % Medium riskJacqueline Fiffe Submission UUID: 7151ce99-b74a-33af-0662-4c63927d5154

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Nursing: Lithium

Jacqueline Fiffe

Florida National University

Psychopharmacology for Advanced Practice Nursing-DFX-DL01

Dr. Tashara R Jean

January 20, 2024

Nursing: Lithium

1. Uses

Lithium is a mood stabilizer. It was first FDA approved in 1970 and maintains its position as the primary treatment for bipolar illness even if there are other

mood stabilizers available. Bipolar disorder ranks among the most afflicting serious mental illnesses due to its high rates of individual and societal impairment

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(Fiorillo et al., 2023). Its patients are often treated using both pharmacological and non-pharmacological interventions. There are few treatments as effective as lithium. When treating bipolar disorder, lithium is often given to patients who have experienced manic episodes in the past as maintenance therapy and to individuals who currently have a manic episode due to the disorder. Lithium has shown success in managing manic symptoms such as heightened excitement, excessive energy, impulsivity, decreased need for sleep, racing thoughts, rapid speech, increased goal-directed activity, and difficulty maintaining attention (Volkmann et al., 2020). Lithium reduces manic symptoms within one to three weeks of starting therapy 2. Off-label uses

Lithium's mood-stabilizing properties make it beneficial off-label for conditions like Alzheimer's disease, schizophrenia, alcohol use disorder, and certain types of depression like MDD. In Alzheimer's disease, it mitigates mood fluctuations associated with cognitive decline (Ishii et al., 2021). In schizophrenia, lithium's mood- stabilizing effect complements antipsychotic medications, aiding in symptom management. For alcohol use disorder, it addresses mood disturbances linked to alcohol withdrawal or cravings. In major depressive disorder, lithium's mood-stabilizing action contributes to long-term symptom control. In addition, lithium is sometimes considered to augment treatment-resistant depression. Lithium is used with standard antidepressant medications to improve the treatment response in individuals who have not adequately responded to traditional antidepressant therapy alone. 3. Contraindications

Lithium should not be prescribed to individuals with renal impairment and cardiovascular disease, as it can induce “reversible T wave changes” and cause “Brugada syndrome.” This is a life-threatening cardiac condition characterized by abnormal heart rhythms. Lithium-induced T wave changes may exacerbate this condition and pose an increased risk of severe arrhythmias. This makes it necessary to avoid prescribing lithium in individuals with renal impairment and cardiovascular disease. In addition, vigilance should be taken while using it in children younger than twelve years old because there is not enough information on the safety and effectiveness of lithium in this demographic. Furthermore, lithium is not recommended during pregnancy as “it is associated with a risk of a 2 to 3 fold increase in significant congenital disabilities like Ebstein's anomaly” (Senner et al., 2021). However, if administered during pregnancy, the patient should be monitored occasionally to manage adverse effects. Lastly, lithium is not recommended for nursing women as lithium can go into breast milk and case adverse side effects to the breastfeeding child. 4. Mechanism of action

Lithium's mechanism of action is not understood. However, it is known to modify sodium transport in nerve and muscle cells and alter neurotransmitter

metabolism, i.e., catecholamines and serotonin. This modulation extends to intracellular signaling through second messenger systems, impacting neurotransmission via the “phosphatidylinositol secondary messenger system. The drug also lowers “protein kinase C” actions. This influences genomic expression associated with neurotransmission. It seems to enhance “cytoprotective proteins, activate neurogenesis, and increase gray matter volume.” Despite rapid absorption, a small volume of distribution, and urinary excretion unchanged, the specific details of lithium's impact on these pathways contribute to its mood-stabilizing effects in bipolar disorder. 5. Potential side effects

Lithium's side effects can be either in the short-term or in the long-term. They can also be due to an extended use of lithium. In the short term, individuals may experience “stomach discomfort, mild nausea, diarrhea, vertigo, dizziness, muscle weakness, and a feeling of confusion”. These initial side effects improve or resolve within a few days. In the long-term, individuals can experience persistent tremors, fatigue, increased thirst, frequent urination, stomach upset, weight changes, metallic taste, acne, rash, and headaches. Healthcare providers should therefore not only consider the benefits of lithium in mood stabilization, they should also acknowledge these side effects. Furthermore, using lithium for a long time may impact kidney and thyroid function. This shows a need for regular blood tests to monitor kidney function, thyroid gland health, and parathyroid gland activity for individuals taking lithium for long periods. 6. Lab

monitoring/ follow up

Before starting lithium medication, patients should have their thyroid and kidney functions checked. In addition, people over the age of fifty years should get an electrocardiogram (ECG). Patients using lithium should retake the tests at least once every six months. Additionally, patients should note their weight before beginning medication with lithium due to the fact that the drug might cause weight increase or decrease. It is also advised to check for any chronic illnesses, such diabetes, in the patient. For the purpose of monitoring therapeutic lithium levels, trough plasma levels should be delivered 8-12 hours following the last dose. Patients should also be monitored every one to two weeks until the targeted therapeutic levels are reached. In addition, patients should be checked for dehydration because lithium might cause dehydration. It is important to keep an eye on the patient and reduce the dosage if symptoms like diarrhea, excessive perspiration, or infection develop. 7. The psychiatric mental health nurse practitioner

To prescribe lithium, the PMHNP conducts a psychiatric assessment to evaluate the patient's mental health history, presenting symptoms, and any coexisting conditions. This assessment determines the appropriateness of lithium therapy. The PMHNP considers factors such as past treatment responses, medical history, comorbidities, and potential contraindications. Once the decision to prescribe lithium is made, the PMHNP initiates the treatment and determines the appropriate dosage. They observe the variability in individual responses, closely monitor the patient's clinical status and adjust the dosage as needed. They do this by engaging in ongoing communication with the patient to assess any emerging side effects. Furthermore, the PMNH, conducts regular follow-up appointments. They use these appointments to monitor the patient's response to treatment, assess for adverse effects, and conduct routine laboratory tests to evaluate lithium levels and potential impacts on kidney and thyroid function (Moalla et al., 2022). They use the data gained to make informed decisions about maintaining, adjusting, or discontinuing lithium therapy. They also use these follow-up appointments to address any psychosocial factors influencing treatment adherence and overall well-being. In addition, the PMNH, educates the patient in order to empower them with knowledge about lithium therapy. They educate patients on the importance of adhering to prescribed dosages, recognizing and reporting potential side effects, and understanding the necessity of routine laboratory monitoring. They also clearly communicate about the expected duration of treatment, potential benefits, and possible challenges.

References

Fiorillo, A., Sampogna, G., Albert, U., Maina, G., Perugi, G., Pompili, M., Rosso, G., Sani, G., & Tortorella, A. (2023). Facts and myths about the use of lithium for

bipolar disorder in routine clinical practice: An expert consensus paper. Annals of General Psychiatry, 22(1). https://doi.org/10.1186/s12991-023-00481-y

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Ishii, N., Terao, T., & Hirakawa, H. (2021). The present state of lithium for the prevention of dementia related to alzheimer’s dementia in clinical and epidemiological studies: A critical review. International Journal of Environmental Research and Public Health, 18(15), 7756.

https://doi.org/10.3390/ijerph18157756

Moalla, M., Larnaout, A., Skhiri, D., Lansari, R., Staali, N., & Melki, W. (2022). Role of nurses in the initiation and the monitoring of lithium. European Psychiatry, 65(S1). https://doi.org/10.1192/j.eurpsy.2022.470

Senner, F., Kohshour, M. O., Abdalla, S., Papiol, S., & Schulze, T. G. (2021). The genetics of response to and side effects of lithium treatment in Bipolar

disorder: Future research perspectives. Frontiers in Pharmacology, 12. https://doi.org/10.3389/fphar.2021.638882 Volkmann, C., Bschor, T., & Köhler,

S. (2020). Lithium treatment over the lifespan in bipolar disorders. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00377

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Florida National University

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Off-label uses

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The psychiatric mental health nurse practitioner

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Psychiatric and Mental Health Nurse Practitioner, FNU

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Facts and myths about the use of lithium for bipolar disorder in routine clinical practice: An expert consensus paper. Annals of General Psychiatry, 22(1). https://doi.org/10.1186/s12991-023-00481-y

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Facts and myths about the use of lithium for bipolar disorder in routine clinical practice an expert consensus paper Annals of General Psychiatry, 22(1) https://doi.org/10.1186/s12991-023-00481-y Kamal, Z

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a critical review"

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https://doi.org/10.1016/j.pec.2022.03.006

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Senner, F., Kohshour, M. O., Abdalla, S., Papiol, S., & Schulze, T.

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Senner, F., Kohshour, M O., Abdalla, S., Papiol, S., & Schulze, T

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