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class, action, dosage range, drug metabolism, adverse effects, monitoring parameters, and nursing interventions

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Lithium is in a class of medications called antimanic agents.  While the specific biochemical mechanism of lithium is still unknown, we do see lithium alter the sodium transport in nerve and muscle cells to shift the intra-neuronal metabolism of catecholamines.  Lithium acts as sodium in the body, it is absorbed in the intestinal tract through the sodium Chanel and is excreted through the kidneys.  The risk for lithium toxicity is high among those with renal or cardiovascular disease, as well as anyone with a severe debilitation, dehydration, or sodium depletion(Eskalith, 2006).  Toxicity occurs at doses close to therapeutic levels, due to lithiums narrow therapeutic index.  Therefore close monitoring is necessary.  When treatment begins the patient must have his serum levels monitored every one to three days, and every two to three months after that (Adams, 2018).  If toxicity occurs,  the patient will be treated with hemodialysis and supportive care.  If taken during pregnancy potential hazard to the fetus may occur.  Data links lithium births to an increase in cardiac and other abnormalities, such as Ebstein’s anomaly.(Allen, 2016)

After reviewing the above information I enter John’s room to discuss the following.  Hello John, I would like to discuss your diagnosis and medications with you and make sure you don’t leave here today with any questions.  I understand you have been experiencing some changes in your mood, as well as your activity and energy levels.  The physician has diagnosed you with bipolar disorder, and we will be sending you home today with a prescription of Eskalith.  
This is a very effective mood stabilizer that has been used for over 50 years.  We are going to ask you to come in every few days to test the amount of lithium in your blood, this is just so we can adjust the dosage to be just right for you, and once your lithium level is stable these blood tests will become less frequent.  If the dosage is too low it will not be effective, and if it is too high it can be harmful.  It is very important for you and your family to watch for early toxic symptoms and contact us immediately if you start experiencing diarrhea, vomiting, tremors, drowsiness, muscular weakness or if you feel like you are losing control of your body movements.  I will suggest you refrain from driving or operating machinery during your adjustment period.  Make sure you drink a lot of water and 

Eskalith – FDA prescribing information, side effects and uses. (2006, May). Retrieved January 18, 2018, from https://www.drugs.com/pro/eskalith.html
Allen, H. (2016, June 20). Lithium. Retrieved January 18, 2018, from https://patient.info/medicine/lithium-tablets-and-liquid-medicine-camcolit-liskonum-priadel-li-liquid

Adams, M. (2018). Pharmacology for nurses: a pathophysiological approach (4th ed.). Toronto: Pearson Canada Inc.

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