Medication Toxicities

LITHIUM

  • Used for → bipolar disorder

  • Therapeutic level: 0.6-1.2

  • Causes of increased lithium level can include → decreased Na intake, fluid & electrolyte loss (due to diaphoresis, dehydration, vomiting, diarrhea, diuretics, illness, OD)

  • Levels should be check when after initiation → frequently & then every 1-2 months or whenever any behavioral change suggested an altered level

    • What time of day would these levels be checked? am, 12 hours after last dose

  • DO NOT TAKE IF PREGNANT → crosses placenta & can cause fetal toxicity

  • Potential side effects: polyuria, polydipsia, edema, dysrhythmia, anorexia, nausea, dry mouth/mild thirst, abd bloating, soft stool or diarrhea, fine hand tremors, inability to concentrate, muscle weakness, headache, hypothyroidism and goiter

  • Interventions:

    • monitor pts who are suicidal (esp during improved moods & increased energy levels - more likely to attempt when like this)

    • take w/ food

    • avoid coffee, tea, cola

    • no diuretics, alcohol, OTC meds

    • what to do for a missed dose → take if within 2 hours of scheduled time - if not, wait and take at the next scheduled time

    • educate pt on s/s of toxicity

    • educate pt to tell dr if they have persistent → polyuria, vomiting, diarrhea, or if fever occurs

    • MONITOR → EKG, renal tests, thyroid, weight

  • Toxicity:

    • Mild → level 1.5; apathy, lethargy, diminished concentration, mild ataxia, coarse hand tremors, slight muscle weakness

    • Moderate → 1.5-2; n/v, severe diarrhea, mild-mod ataxia & incoordination, slurred speech, tinnitus, blurred vision, muscle twitching, irregular tremor

    • Severe → 2+; nystagmus, muscle fasciculations, DT hyperreflexia, visual/tactile hallucinations, oliguria, anuria, impaired LOC, tonic-clonic seizures or coma which can lead to death

  • Interventions for toxicity → withhold lithium & notify PCP; monitor v/s, LOC, cardiac status; obtain samples to monitor lithium, electrolytes, BUN, creatinine, CBC; monitor for suicidal tendencies & implement suicide precautions

HIGHLIGHTS IN SAUNDERS

  • Lithium education to help prevent toxicity → 6-8oz of water/day, adequate salt intake

  • The nurse ahs a pt who has been taking alprazolam long-term and the DR is discontinuing the med. The nurse needs to educate the pt about how to taper the medication: taper gradually over 2-6 weeks; abrupt or too rapid withdrawal can lead to restlessness/irritability/insomnia/hand tremors/abd muscle cramps/sweating/vomiting/seizures; if any s/s occur during tapering to let the MD know