SlideShare a Scribd company logo
WELCOME
ANY GUESS….???
INTRODUCTION
Psychopharmacology is the study of drugs used to treat psychiatric
disorders. They have significant effect on higher mental functions. They
work by adjusting levels of brain chemicals, or neurotransmitters, like
dopamine, gamma aminobutyric acid (GABA), norepinephrine, and
serotonin.
THE CLASSIFICATION OF DRUGS INCLUDES:
• Antipsychotic agents
• Antidepressant agents
• Mood stabilizing agent
• Anxiolytics and Hypnos sedatives
• Anti epileptic drugs
• Anti parkinsonian drugs
• Miscellaneous
MOOD STABILIZER
Any medication that is able to decrease vulnerability to
subsequent episodes of mania or depression and not
exacerbate the current episode or maintenance phase of
treatment.
- GARY.S – (1996)
Commonly used mood stabilizers are
 Lithium
 Carbamazepine
 Sodium valproate
LITHIUM
DESCRIPTION
 Lithium is used to treat and prevent episodes of mania in
people with bipolar disorder (manic-depressive disorder; a
disease that causes episodes of depression, episodes of
mania, and other abnormal moods).
 It works by decreasing abnormal activity in the brain.
 Lithium therapy remains a key component in the treatment
of psychiatric conditions where the main symptoms are
mood changes but requires strict monitoring.
HISTORY
YEAR NAME DISCOVERED
In 1817 Johan August
Arfvedson
Lithium was discovered
as a chemical element
In 1847 Garrod Lithium treatment for
gout
In 1870 Silas weir Lithium bromide as an
anticonvulsant and a
hypnotic
In 1871, William Hammond First recorded use of
lithium for mania
In 1894 Fredrick Used in the prevention
of melancholic
depression
In 1949 John Cade Rediscovered the use of
lithium for mania
In 1970 FDA Approved the use of
lithium for mania
MECHANISM OF ACTION
BRAIN STRUCTURE
NEUROTRANSMITTER
MODULATIONS
INTRACELLULAR
CHANGES
MULTIPLE
LEVELS OF
ACTION OF
LITHIUM
But the exact mechanism of action of lithium is
unknown.
PATHOPHYSIOLOGY
PHARMACOKINETICS
 Half life – 18 – 24hrs
 Lithium is readily absorbed with peak plasma levels
occuring 2 – 4 hours after a single oral dose of lithium
carbonate
 Lithium is distributed rapidly in liver, kidney, muscle, bone
and brain.
 Elimination is predominantly 95% via kidneys and is
influenced by sodium balance
 Depletion of sodium can precipitate lithium toxicity
DOSAGE
 Lithium is available in the form of following preparation:
 Lithium carbonate 300mg (Licab)
 400mg sustained release tablets (lithosun – SR)
 Lithium citrate 300mg/5ml liquid
Contd..
 The usual range of dose per day in acute mania is 900 –
2100mg given in 2 – 3divided doses.
 The treatment is started with after serial lithium
estimation is done after a loading dose of 600mg or
900mg of lithium to determine the pharmacokinetics.
INDICATIONS
ACUTE MANIA PROPHYLAXIS FOR BIPOLAR
AND UNIPOLAR MOOD
DISORDER
SCHIZOAFFECTIVE DISODER BORDERLINE PERSONALITY
DISORDER
BULLIMIA NERVOSA BINGE DRINKING
CLUSTER HEADACHE NEUTROPENIA
OTHER INDICATIONS
CYCLOTHYMIA IMPULSIVITY AND
AGGRESSION
TRICHOTILLOMANIA
CONTRA INDICATIONS
 Cardiovascular disease
 Concomitant use of diuretics
 Debilitation
 Dehydration
 Renal diseases, sodium depletion
 Pregnancy
LITHIUM LEVEL..??
LEVELS OF LITHIUM
TOXICITY
 Mild Lithium toxicity – reaches 1.5 mEq/L or higher
 Moderate toxicity – 2.0 mEq/L and above which is life
threatening in rare cases.
 Levels of 3.0 mEq/L and higher are considered as medical
emergency.
ADVERSE EFFECTS
L – Leucocytosis
I – Insipidus(Diabetic)
T – Tremors, teratogenicity
H – Hypothyroidism
I – Increased weight gain
U – Vomiting(GI disturbances)
M - Miscellaneous – ECG changes, Acne
SYSTEM
1. NEUROLOGICAL
Tremors, motor hyperactivity,
muscular weakness, cogwheel
rigidity, seizures, neurotoxicity
2. RENAL
Polydipsia, polyuria, tubular
enlargement, nephritic syndrome
3. CARDIOVASCULAR:
T – WAVE depression
4. GATROINTESTINAL
Nausea, vomiting, diaarhoea,
abdominal pain and metallic taste
5. ENDOCRINE
Abnormal thyroid function, goitre,
weight gain
7. PREGNANCY &
LACTATION
Teratogenic possibility
Increased incidence of ebstein’s
anomaly
Secretes in milk and causes toxiity
in infant
6. DERMATOLOGICAL
Acniform eruptions,
populareruptions and exacerbation
of psoriasis
LITHIUM TOXICITY
MEANING
Lithium toxicity is another term for a lithium overdose or
poisoning
Lithium is similar to sodium. In addition, lithium may inhibit
the release of monoamines from nerve endings and increase
their uptake.
TYPES OF POISONING:
1. ACUTE POISONING –voluntary or accidental ingestion
in untreated patient
2. ACUTE ON CHRONIC – Voluntary or accidental
ingestion in patient currently using lithium
3. CHRONIC OR THERAPEUTIC – progressive lithium
toxicity in a patient on lithium therapy.
SIGNS & SYMPTOMS
 MILD – MODERATE TOXICITY:
 Generalized weakness
 Fine resting tremor
 Mild confusions
 MODERATE – SEVERE TOXICITY:
 Severe tremors
 Muscle fasciculations
 Stupor
 Seizures
 COMA
 Signs of cardiovascular collapse
LITHIUM TOXICITY
EFFECTS
SYMPTOMS WITH CHRONIC
TOXICITY
LEVEL SYMPTOMS
0.5 mEq/L NONE
1.0 mEq/L MILD TREMOR
1.5 mEq/L COARSE TREMOR
2.0 mEq/L HYPERREFLEXIA
DYSARTHRIA
2.5 mEq/L MYOCLONIA, ATAXIA,CONFUSION
> 3.0 mEq/L DELIRIUM, COMA, SEIZURES
COMPLICATIONS
 Truncal and gait ataxia
 Nystagmus
 Hypertonicity
 Short term memory deficits
 Dementia( rare)
PROGNOSIS:
Most cases of lithium toxicity result in a favourable
outcome; however up to 10% of individuals are with
severe toxicity.
MANAGEMENT
 There is no specific antidote for lithium toxicity
 Vital signs monitoring – unusual signs
 Lab studies – serum lithium level, electrolytes, RFT and
ECG as soon as possible
 Gastric lavage or bowel irrigation – if have taken lithium
within one hour.
 IV fluids – to restore electrolyte balance
 Hemodialysis – to remove excess lithium from blood
 Medication – if seizure occurs
NURSE’S RESPONSIBILITY
 Baseline evaluation – ECG, LFT, RFT, urine analysis
 Serum lithium levels should be monitored every 3 – 4 days
during initial phase of therapy and every 1 – 2 months,
weekly monitoring.
 Lithium should be monitored at the 12th hour of last dose.
 Assess of increased urine output, persistent thirst is
important
 Assess for therapeutic response
PATIENT EDUCATION
 Lithium should be taken after meals
 Take as directed
 Do not discontinue the drug except physician advice.
 Thirst and frequent urination may occur
 Oral fluid intake of 2 – 3lit/day and normal intake of salt to
avoid dehydration.
 Educate about side effects and Advice to inform
immediately when side effects are notified.
 Inform about the regular checkup.
TO RECAPITULATE…
ANY
QUESTIONS??
REFERENCES
 Abou-Saleh MT, Coppen A. The efficacy of low-dose
lithium: clinical, psychological and biological correlates. J
Psychiatr Res. 1989;23:157–162. doi: 10.1016/0022-
3956(89)90006-X
 Bschor T. Lithium in the treatment of major depressive
disorder. Drugs. 2014;74:855–62.
 Erden A, et al. Lithium intoxication and nephrogenic
diabetes insipidus: a case report and review of literature. Int
J Gen Med. 2013;6:535–9.
 Jaeger A, et al. When should dialysis be performed in
lithium poisoning? A kinetic study in 14 cases of lithium
poisoning. J Toxicol Clin Toxicol. 1993;31(3):429–47.
THANK YOU….

More Related Content

What's hot

Mania. bipolar disorder. manic disorder
Mania. bipolar disorder. manic disorderMania. bipolar disorder. manic disorder
Mania. bipolar disorder. manic disorder
mamtabisht10
 
Mood stabilizers
Mood stabilizersMood stabilizers
Mood stabilizers
MaryamAbdulqadir
 
Mood disorder
Mood disorderMood disorder
Mood disorder
Vipin Chandran
 
Psychopharmacology
PsychopharmacologyPsychopharmacology
Psychopharmacology
Nursing Path
 
Antabuse drugs
Antabuse drugsAntabuse drugs
Antabuse therapy
Antabuse therapyAntabuse therapy
Antabuse therapy
Nithiy Uday
 
Delirium
DeliriumDelirium
Delirium
home
 
SCHIZOPHRENIA for B.Sc (Nsg).docx
SCHIZOPHRENIA for B.Sc (Nsg).docxSCHIZOPHRENIA for B.Sc (Nsg).docx
SCHIZOPHRENIA for B.Sc (Nsg).docx
Nithiy Uday
 
Antidepressant.pptx
Antidepressant.pptxAntidepressant.pptx
Antidepressant.pptx
Cherraan's college of Nursing
 
Paranoid schizophrenia
Paranoid schizophreniaParanoid schizophrenia
Paranoid schizophrenia
Dr. sreeremya S
 
Delirium
DeliriumDelirium
Delirium
Neha Bhatt
 
Psychotropic drugs
Psychotropic drugsPsychotropic drugs
Psychotropic drugs
Edgar Manood
 
Electroconvulsive Therapy
Electroconvulsive TherapyElectroconvulsive Therapy
Electroconvulsive Therapy
Monika Kanwar
 
SCHIZOPHRENIA.ppt
SCHIZOPHRENIA.pptSCHIZOPHRENIA.ppt
SCHIZOPHRENIA.ppt
Prof. (Dr.) Rahul Sharma
 
Paranoid schizophrenia
Paranoid schizophrenia Paranoid schizophrenia
Paranoid schizophrenia
BRINCELET M BIJU
 
Qualities of a psychiatric nurse
Qualities of a psychiatric nurseQualities of a psychiatric nurse
Qualities of a psychiatric nurse
Jeslin Mattam
 
Behavior therapy psychiatric nursing
Behavior therapy psychiatric nursingBehavior therapy psychiatric nursing
Behavior therapy psychiatric nursing
LakshmiTiwari4
 
OCD CNT Premnath
OCD CNT PremnathOCD CNT Premnath
OCD CNT Premnath
Premnath Ramachandranpillai
 
Lithium.pptx
Lithium.pptxLithium.pptx
Mania
ManiaMania

What's hot (20)

Mania. bipolar disorder. manic disorder
Mania. bipolar disorder. manic disorderMania. bipolar disorder. manic disorder
Mania. bipolar disorder. manic disorder
 
Mood stabilizers
Mood stabilizersMood stabilizers
Mood stabilizers
 
Mood disorder
Mood disorderMood disorder
Mood disorder
 
Psychopharmacology
PsychopharmacologyPsychopharmacology
Psychopharmacology
 
Antabuse drugs
Antabuse drugsAntabuse drugs
Antabuse drugs
 
Antabuse therapy
Antabuse therapyAntabuse therapy
Antabuse therapy
 
Delirium
DeliriumDelirium
Delirium
 
SCHIZOPHRENIA for B.Sc (Nsg).docx
SCHIZOPHRENIA for B.Sc (Nsg).docxSCHIZOPHRENIA for B.Sc (Nsg).docx
SCHIZOPHRENIA for B.Sc (Nsg).docx
 
Antidepressant.pptx
Antidepressant.pptxAntidepressant.pptx
Antidepressant.pptx
 
Paranoid schizophrenia
Paranoid schizophreniaParanoid schizophrenia
Paranoid schizophrenia
 
Delirium
DeliriumDelirium
Delirium
 
Psychotropic drugs
Psychotropic drugsPsychotropic drugs
Psychotropic drugs
 
Electroconvulsive Therapy
Electroconvulsive TherapyElectroconvulsive Therapy
Electroconvulsive Therapy
 
SCHIZOPHRENIA.ppt
SCHIZOPHRENIA.pptSCHIZOPHRENIA.ppt
SCHIZOPHRENIA.ppt
 
Paranoid schizophrenia
Paranoid schizophrenia Paranoid schizophrenia
Paranoid schizophrenia
 
Qualities of a psychiatric nurse
Qualities of a psychiatric nurseQualities of a psychiatric nurse
Qualities of a psychiatric nurse
 
Behavior therapy psychiatric nursing
Behavior therapy psychiatric nursingBehavior therapy psychiatric nursing
Behavior therapy psychiatric nursing
 
OCD CNT Premnath
OCD CNT PremnathOCD CNT Premnath
OCD CNT Premnath
 
Lithium.pptx
Lithium.pptxLithium.pptx
Lithium.pptx
 
Mania
ManiaMania
Mania
 

Similar to Lithium ppt

Mood stabilizing agents
Mood stabilizing agentsMood stabilizing agents
Mood stabilizing agents
Sharika Ratish
 
MOOD STABLIZERS DRUGS.pptx
MOOD     STABLIZERS           DRUGS.pptxMOOD     STABLIZERS           DRUGS.pptx
MOOD STABLIZERS DRUGS.pptx
PoojaSen20
 
lithium toxicity
lithium toxicitylithium toxicity
lithium toxicity
Reejan Paudel
 
Therapeutic modalities in psychiatry
Therapeutic modalities in psychiatryTherapeutic modalities in psychiatry
Therapeutic modalities in psychiatry
Enoch R G
 
therapies in psychiatry 1111111111111111
therapies in psychiatry 1111111111111111therapies in psychiatry 1111111111111111
therapies in psychiatry 1111111111111111
MaryemSafdar2
 
Antimanic drugs and its pharmacology
Antimanic drugs and its pharmacologyAntimanic drugs and its pharmacology
Antimanic drugs and its pharmacology
Koppala RVS Chaitanya
 
Antimaniacs- drugs , bipolar disorder, etc
Antimaniacs- drugs , bipolar disorder, etcAntimaniacs- drugs , bipolar disorder, etc
Antimaniacs- drugs , bipolar disorder, etc
vijiarumugamvsvs
 
Antimanic drugs
Antimanic drugsAntimanic drugs
Antimanic drugs
MangeshBansod2
 
Mood Stabccccccccccffffffffddddilizers.pdf
Mood Stabccccccccccffffffffddddilizers.pdfMood Stabccccccccccffffffffddddilizers.pdf
Mood Stabccccccccccffffffffddddilizers.pdf
EugenMweemba
 
Pharmacology of Drugs used in bipolar disorder & mania
Pharmacology of Drugs used in bipolar disorder & maniaPharmacology of Drugs used in bipolar disorder & mania
Pharmacology of Drugs used in bipolar disorder & mania
shikha dwivedi
 
TDM of Lithium.pdf
TDM of Lithium.pdfTDM of Lithium.pdf
TDM of Lithium.pdf
varshawadnere
 
mood stabilizers.pptx
mood stabilizers.pptxmood stabilizers.pptx
mood stabilizers.pptx
ManmeetKaur216
 
Anti manic drug lithium
Anti manic drug  lithiumAnti manic drug  lithium
Anti manic drug lithium
Rifat Zakir
 
Mood stabilising agents
Mood stabilising agentsMood stabilising agents
Mood stabilising agents
DrSatyabrataSahoo
 
Pharmacotherapy
PharmacotherapyPharmacotherapy
Pharmacotherapy
Hala Sayyah
 
mood stabilizers.pdf 2024updated lithium
mood stabilizers.pdf 2024updated lithiummood stabilizers.pdf 2024updated lithium
mood stabilizers.pdf 2024updated lithium
mohamedbeazak
 
Antidepressants
Antidepressants Antidepressants
Antidepressants
http://neigrihms.gov.in/
 
Mood Stabilizers | Psychotropic Drugs | Mental Health | Juhin J
Mood Stabilizers | Psychotropic Drugs | Mental Health | Juhin JMood Stabilizers | Psychotropic Drugs | Mental Health | Juhin J
Mood Stabilizers | Psychotropic Drugs | Mental Health | Juhin J
Juhin J
 
antimania-210724111151.pptx
antimania-210724111151.pptxantimania-210724111151.pptx
antimania-210724111151.pptx
Imtiyaz60
 
mania disorder.pptx
mania disorder.pptxmania disorder.pptx
mania disorder.pptx
AHEMANTHBABU
 

Similar to Lithium ppt (20)

Mood stabilizing agents
Mood stabilizing agentsMood stabilizing agents
Mood stabilizing agents
 
MOOD STABLIZERS DRUGS.pptx
MOOD     STABLIZERS           DRUGS.pptxMOOD     STABLIZERS           DRUGS.pptx
MOOD STABLIZERS DRUGS.pptx
 
lithium toxicity
lithium toxicitylithium toxicity
lithium toxicity
 
Therapeutic modalities in psychiatry
Therapeutic modalities in psychiatryTherapeutic modalities in psychiatry
Therapeutic modalities in psychiatry
 
therapies in psychiatry 1111111111111111
therapies in psychiatry 1111111111111111therapies in psychiatry 1111111111111111
therapies in psychiatry 1111111111111111
 
Antimanic drugs and its pharmacology
Antimanic drugs and its pharmacologyAntimanic drugs and its pharmacology
Antimanic drugs and its pharmacology
 
Antimaniacs- drugs , bipolar disorder, etc
Antimaniacs- drugs , bipolar disorder, etcAntimaniacs- drugs , bipolar disorder, etc
Antimaniacs- drugs , bipolar disorder, etc
 
Antimanic drugs
Antimanic drugsAntimanic drugs
Antimanic drugs
 
Mood Stabccccccccccffffffffddddilizers.pdf
Mood Stabccccccccccffffffffddddilizers.pdfMood Stabccccccccccffffffffddddilizers.pdf
Mood Stabccccccccccffffffffddddilizers.pdf
 
Pharmacology of Drugs used in bipolar disorder & mania
Pharmacology of Drugs used in bipolar disorder & maniaPharmacology of Drugs used in bipolar disorder & mania
Pharmacology of Drugs used in bipolar disorder & mania
 
TDM of Lithium.pdf
TDM of Lithium.pdfTDM of Lithium.pdf
TDM of Lithium.pdf
 
mood stabilizers.pptx
mood stabilizers.pptxmood stabilizers.pptx
mood stabilizers.pptx
 
Anti manic drug lithium
Anti manic drug  lithiumAnti manic drug  lithium
Anti manic drug lithium
 
Mood stabilising agents
Mood stabilising agentsMood stabilising agents
Mood stabilising agents
 
Pharmacotherapy
PharmacotherapyPharmacotherapy
Pharmacotherapy
 
mood stabilizers.pdf 2024updated lithium
mood stabilizers.pdf 2024updated lithiummood stabilizers.pdf 2024updated lithium
mood stabilizers.pdf 2024updated lithium
 
Antidepressants
Antidepressants Antidepressants
Antidepressants
 
Mood Stabilizers | Psychotropic Drugs | Mental Health | Juhin J
Mood Stabilizers | Psychotropic Drugs | Mental Health | Juhin JMood Stabilizers | Psychotropic Drugs | Mental Health | Juhin J
Mood Stabilizers | Psychotropic Drugs | Mental Health | Juhin J
 
antimania-210724111151.pptx
antimania-210724111151.pptxantimania-210724111151.pptx
antimania-210724111151.pptx
 
mania disorder.pptx
mania disorder.pptxmania disorder.pptx
mania disorder.pptx
 

More from RuppaMercy

Self concept and self esteem
Self concept and self esteemSelf concept and self esteem
Self concept and self esteem
RuppaMercy
 
Psychopathology and Neurotransmission
Psychopathology and NeurotransmissionPsychopathology and Neurotransmission
Psychopathology and Neurotransmission
RuppaMercy
 
Promoting self concept
Promoting self conceptPromoting self concept
Promoting self concept
RuppaMercy
 
Adaptation and maladaptation, Crisis, stress and defense mechanism
Adaptation and maladaptation, Crisis, stress and defense mechanismAdaptation and maladaptation, Crisis, stress and defense mechanism
Adaptation and maladaptation, Crisis, stress and defense mechanism
RuppaMercy
 
Women and mental health
Women and mental healthWomen and mental health
Women and mental health
RuppaMercy
 
Problem based learning
Problem based learningProblem based learning
Problem based learning
RuppaMercy
 
Discipline and recruitment
Discipline and recruitmentDiscipline and recruitment
Discipline and recruitment
RuppaMercy
 
COLLABORATIVE ISSUES AND MODELS IN NURSING
COLLABORATIVE ISSUES AND MODELS IN NURSINGCOLLABORATIVE ISSUES AND MODELS IN NURSING
COLLABORATIVE ISSUES AND MODELS IN NURSING
RuppaMercy
 
PDD
PDDPDD
MEETING NUTRITIONAL NEEDS
MEETING NUTRITIONAL NEEDSMEETING NUTRITIONAL NEEDS
MEETING NUTRITIONAL NEEDS
RuppaMercy
 
BLOOD TRANSFUSION
BLOOD TRANSFUSIONBLOOD TRANSFUSION
BLOOD TRANSFUSION
RuppaMercy
 
Delirium
DeliriumDelirium
Delirium
RuppaMercy
 
Behavioral therapy
Behavioral therapyBehavioral therapy
Behavioral therapy
RuppaMercy
 
Principles and standards of psychiatric nursing
Principles and standards of psychiatric nursingPrinciples and standards of psychiatric nursing
Principles and standards of psychiatric nursing
RuppaMercy
 
Alterations in body temperature
Alterations in body temperatureAlterations in body temperature
Alterations in body temperature
RuppaMercy
 
Occupational health and safety
Occupational health and safetyOccupational health and safety
Occupational health and safety
RuppaMercy
 
Legal issues in nursing
Legal issues in nursingLegal issues in nursing
Legal issues in nursing
RuppaMercy
 
Psychosocial rehabilitation
Psychosocial rehabilitationPsychosocial rehabilitation
Psychosocial rehabilitation
RuppaMercy
 
Psychiatric emergencies
Psychiatric emergenciesPsychiatric emergencies
Psychiatric emergencies
RuppaMercy
 
National Mental Health Policy
National Mental Health PolicyNational Mental Health Policy
National Mental Health Policy
RuppaMercy
 

More from RuppaMercy (20)

Self concept and self esteem
Self concept and self esteemSelf concept and self esteem
Self concept and self esteem
 
Psychopathology and Neurotransmission
Psychopathology and NeurotransmissionPsychopathology and Neurotransmission
Psychopathology and Neurotransmission
 
Promoting self concept
Promoting self conceptPromoting self concept
Promoting self concept
 
Adaptation and maladaptation, Crisis, stress and defense mechanism
Adaptation and maladaptation, Crisis, stress and defense mechanismAdaptation and maladaptation, Crisis, stress and defense mechanism
Adaptation and maladaptation, Crisis, stress and defense mechanism
 
Women and mental health
Women and mental healthWomen and mental health
Women and mental health
 
Problem based learning
Problem based learningProblem based learning
Problem based learning
 
Discipline and recruitment
Discipline and recruitmentDiscipline and recruitment
Discipline and recruitment
 
COLLABORATIVE ISSUES AND MODELS IN NURSING
COLLABORATIVE ISSUES AND MODELS IN NURSINGCOLLABORATIVE ISSUES AND MODELS IN NURSING
COLLABORATIVE ISSUES AND MODELS IN NURSING
 
PDD
PDDPDD
PDD
 
MEETING NUTRITIONAL NEEDS
MEETING NUTRITIONAL NEEDSMEETING NUTRITIONAL NEEDS
MEETING NUTRITIONAL NEEDS
 
BLOOD TRANSFUSION
BLOOD TRANSFUSIONBLOOD TRANSFUSION
BLOOD TRANSFUSION
 
Delirium
DeliriumDelirium
Delirium
 
Behavioral therapy
Behavioral therapyBehavioral therapy
Behavioral therapy
 
Principles and standards of psychiatric nursing
Principles and standards of psychiatric nursingPrinciples and standards of psychiatric nursing
Principles and standards of psychiatric nursing
 
Alterations in body temperature
Alterations in body temperatureAlterations in body temperature
Alterations in body temperature
 
Occupational health and safety
Occupational health and safetyOccupational health and safety
Occupational health and safety
 
Legal issues in nursing
Legal issues in nursingLegal issues in nursing
Legal issues in nursing
 
Psychosocial rehabilitation
Psychosocial rehabilitationPsychosocial rehabilitation
Psychosocial rehabilitation
 
Psychiatric emergencies
Psychiatric emergenciesPsychiatric emergencies
Psychiatric emergencies
 
National Mental Health Policy
National Mental Health PolicyNational Mental Health Policy
National Mental Health Policy
 

Recently uploaded

How to Manage Shipping Connectors & Shipping Methods in Odoo 17
How to Manage Shipping Connectors & Shipping Methods in Odoo 17How to Manage Shipping Connectors & Shipping Methods in Odoo 17
How to Manage Shipping Connectors & Shipping Methods in Odoo 17
Celine George
 
DepEd School Calendar 2024-2025 DO_s2024_008
DepEd School Calendar 2024-2025 DO_s2024_008DepEd School Calendar 2024-2025 DO_s2024_008
DepEd School Calendar 2024-2025 DO_s2024_008
Glenn Rivera
 
11EHS Term 3 Week 1 Unit 1 Review: Feedback and improvementpptx
11EHS Term 3 Week 1 Unit 1 Review: Feedback and improvementpptx11EHS Term 3 Week 1 Unit 1 Review: Feedback and improvementpptx
11EHS Term 3 Week 1 Unit 1 Review: Feedback and improvementpptx
mansk2
 
How to Manage Early Receipt Printing in Odoo 17 POS
How to Manage Early Receipt Printing in Odoo 17 POSHow to Manage Early Receipt Printing in Odoo 17 POS
How to Manage Early Receipt Printing in Odoo 17 POS
Celine George
 
A beginner’s guide to project reviews - everything you wanted to know but wer...
A beginner’s guide to project reviews - everything you wanted to know but wer...A beginner’s guide to project reviews - everything you wanted to know but wer...
A beginner’s guide to project reviews - everything you wanted to know but wer...
Association for Project Management
 
Node JS Interview Question PDF By ScholarHat
Node JS Interview Question PDF By ScholarHatNode JS Interview Question PDF By ScholarHat
Node JS Interview Question PDF By ScholarHat
Scholarhat
 
Introduction to Google Productivity Tools for Office and Personal Use
Introduction to Google Productivity Tools for Office and Personal UseIntroduction to Google Productivity Tools for Office and Personal Use
Introduction to Google Productivity Tools for Office and Personal Use
Excellence Foundation for South Sudan
 
Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...
Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...
Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...
Codeavour International
 
C# Interview Questions PDF By ScholarHat.pdf
C# Interview Questions PDF By ScholarHat.pdfC# Interview Questions PDF By ScholarHat.pdf
C# Interview Questions PDF By ScholarHat.pdf
Scholarhat
 
2 Post harvest Physiology of Horticulture produce.pptx
2 Post harvest Physiology of Horticulture  produce.pptx2 Post harvest Physiology of Horticulture  produce.pptx
2 Post harvest Physiology of Horticulture produce.pptx
UmeshTimilsina1
 
Mail Server Configuration Using App passwords in Odoo 17
Mail Server Configuration Using App passwords in Odoo 17Mail Server Configuration Using App passwords in Odoo 17
Mail Server Configuration Using App passwords in Odoo 17
Celine George
 
Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...
Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...
Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...
National Information Standards Organization (NISO)
 
Parent PD Design for Professional Development .docx
Parent PD Design for Professional Development .docxParent PD Design for Professional Development .docx
Parent PD Design for Professional Development .docx
AntonioJarligoCompra
 
Benchmarking Sustainability: Neurosciences and AI Tech Research in Macau - Ke...
Benchmarking Sustainability: Neurosciences and AI Tech Research in Macau - Ke...Benchmarking Sustainability: Neurosciences and AI Tech Research in Macau - Ke...
Benchmarking Sustainability: Neurosciences and AI Tech Research in Macau - Ke...
Alvaro Barbosa
 
Open Source and AI - ByWater Closing Keynote Presentation.pdf
Open Source and AI - ByWater Closing Keynote Presentation.pdfOpen Source and AI - ByWater Closing Keynote Presentation.pdf
Open Source and AI - ByWater Closing Keynote Presentation.pdf
Jessica Zairo
 
1. Importance_of_reducing_postharvest_loss.pptx
1. Importance_of_reducing_postharvest_loss.pptx1. Importance_of_reducing_postharvest_loss.pptx
1. Importance_of_reducing_postharvest_loss.pptx
UmeshTimilsina1
 
The Cruelty of Animal Testing in the Industry.pdf
The Cruelty of Animal Testing in the Industry.pdfThe Cruelty of Animal Testing in the Industry.pdf
The Cruelty of Animal Testing in the Industry.pdf
luzmilaglez334
 
Brigada Eskwela 2024 PowerPoint Update for SY 2024-2025
Brigada Eskwela 2024 PowerPoint Update for SY 2024-2025Brigada Eskwela 2024 PowerPoint Update for SY 2024-2025
Brigada Eskwela 2024 PowerPoint Update for SY 2024-2025
ALBERTHISOLER1
 
View Inheritance in Odoo 17 - Odoo 17 Slides
View Inheritance in Odoo 17 - Odoo 17  SlidesView Inheritance in Odoo 17 - Odoo 17  Slides
View Inheritance in Odoo 17 - Odoo 17 Slides
Celine George
 
PRESS RELEASE - UNIVERSITY OF GHANA, JULY 16, 2024.pdf
PRESS RELEASE - UNIVERSITY OF GHANA, JULY 16, 2024.pdfPRESS RELEASE - UNIVERSITY OF GHANA, JULY 16, 2024.pdf
PRESS RELEASE - UNIVERSITY OF GHANA, JULY 16, 2024.pdf
nservice241
 

Recently uploaded (20)

How to Manage Shipping Connectors & Shipping Methods in Odoo 17
How to Manage Shipping Connectors & Shipping Methods in Odoo 17How to Manage Shipping Connectors & Shipping Methods in Odoo 17
How to Manage Shipping Connectors & Shipping Methods in Odoo 17
 
DepEd School Calendar 2024-2025 DO_s2024_008
DepEd School Calendar 2024-2025 DO_s2024_008DepEd School Calendar 2024-2025 DO_s2024_008
DepEd School Calendar 2024-2025 DO_s2024_008
 
11EHS Term 3 Week 1 Unit 1 Review: Feedback and improvementpptx
11EHS Term 3 Week 1 Unit 1 Review: Feedback and improvementpptx11EHS Term 3 Week 1 Unit 1 Review: Feedback and improvementpptx
11EHS Term 3 Week 1 Unit 1 Review: Feedback and improvementpptx
 
How to Manage Early Receipt Printing in Odoo 17 POS
How to Manage Early Receipt Printing in Odoo 17 POSHow to Manage Early Receipt Printing in Odoo 17 POS
How to Manage Early Receipt Printing in Odoo 17 POS
 
A beginner’s guide to project reviews - everything you wanted to know but wer...
A beginner’s guide to project reviews - everything you wanted to know but wer...A beginner’s guide to project reviews - everything you wanted to know but wer...
A beginner’s guide to project reviews - everything you wanted to know but wer...
 
Node JS Interview Question PDF By ScholarHat
Node JS Interview Question PDF By ScholarHatNode JS Interview Question PDF By ScholarHat
Node JS Interview Question PDF By ScholarHat
 
Introduction to Google Productivity Tools for Office and Personal Use
Introduction to Google Productivity Tools for Office and Personal UseIntroduction to Google Productivity Tools for Office and Personal Use
Introduction to Google Productivity Tools for Office and Personal Use
 
Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...
Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...
Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...
 
C# Interview Questions PDF By ScholarHat.pdf
C# Interview Questions PDF By ScholarHat.pdfC# Interview Questions PDF By ScholarHat.pdf
C# Interview Questions PDF By ScholarHat.pdf
 
2 Post harvest Physiology of Horticulture produce.pptx
2 Post harvest Physiology of Horticulture  produce.pptx2 Post harvest Physiology of Horticulture  produce.pptx
2 Post harvest Physiology of Horticulture produce.pptx
 
Mail Server Configuration Using App passwords in Odoo 17
Mail Server Configuration Using App passwords in Odoo 17Mail Server Configuration Using App passwords in Odoo 17
Mail Server Configuration Using App passwords in Odoo 17
 
Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...
Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...
Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...
 
Parent PD Design for Professional Development .docx
Parent PD Design for Professional Development .docxParent PD Design for Professional Development .docx
Parent PD Design for Professional Development .docx
 
Benchmarking Sustainability: Neurosciences and AI Tech Research in Macau - Ke...
Benchmarking Sustainability: Neurosciences and AI Tech Research in Macau - Ke...Benchmarking Sustainability: Neurosciences and AI Tech Research in Macau - Ke...
Benchmarking Sustainability: Neurosciences and AI Tech Research in Macau - Ke...
 
Open Source and AI - ByWater Closing Keynote Presentation.pdf
Open Source and AI - ByWater Closing Keynote Presentation.pdfOpen Source and AI - ByWater Closing Keynote Presentation.pdf
Open Source and AI - ByWater Closing Keynote Presentation.pdf
 
1. Importance_of_reducing_postharvest_loss.pptx
1. Importance_of_reducing_postharvest_loss.pptx1. Importance_of_reducing_postharvest_loss.pptx
1. Importance_of_reducing_postharvest_loss.pptx
 
The Cruelty of Animal Testing in the Industry.pdf
The Cruelty of Animal Testing in the Industry.pdfThe Cruelty of Animal Testing in the Industry.pdf
The Cruelty of Animal Testing in the Industry.pdf
 
Brigada Eskwela 2024 PowerPoint Update for SY 2024-2025
Brigada Eskwela 2024 PowerPoint Update for SY 2024-2025Brigada Eskwela 2024 PowerPoint Update for SY 2024-2025
Brigada Eskwela 2024 PowerPoint Update for SY 2024-2025
 
View Inheritance in Odoo 17 - Odoo 17 Slides
View Inheritance in Odoo 17 - Odoo 17  SlidesView Inheritance in Odoo 17 - Odoo 17  Slides
View Inheritance in Odoo 17 - Odoo 17 Slides
 
PRESS RELEASE - UNIVERSITY OF GHANA, JULY 16, 2024.pdf
PRESS RELEASE - UNIVERSITY OF GHANA, JULY 16, 2024.pdfPRESS RELEASE - UNIVERSITY OF GHANA, JULY 16, 2024.pdf
PRESS RELEASE - UNIVERSITY OF GHANA, JULY 16, 2024.pdf
 

Lithium ppt

  • 3. INTRODUCTION Psychopharmacology is the study of drugs used to treat psychiatric disorders. They have significant effect on higher mental functions. They work by adjusting levels of brain chemicals, or neurotransmitters, like dopamine, gamma aminobutyric acid (GABA), norepinephrine, and serotonin. THE CLASSIFICATION OF DRUGS INCLUDES: • Antipsychotic agents • Antidepressant agents • Mood stabilizing agent • Anxiolytics and Hypnos sedatives • Anti epileptic drugs • Anti parkinsonian drugs • Miscellaneous
  • 4. MOOD STABILIZER Any medication that is able to decrease vulnerability to subsequent episodes of mania or depression and not exacerbate the current episode or maintenance phase of treatment. - GARY.S – (1996) Commonly used mood stabilizers are  Lithium  Carbamazepine  Sodium valproate
  • 6. DESCRIPTION  Lithium is used to treat and prevent episodes of mania in people with bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods).  It works by decreasing abnormal activity in the brain.  Lithium therapy remains a key component in the treatment of psychiatric conditions where the main symptoms are mood changes but requires strict monitoring.
  • 7. HISTORY YEAR NAME DISCOVERED In 1817 Johan August Arfvedson Lithium was discovered as a chemical element In 1847 Garrod Lithium treatment for gout In 1870 Silas weir Lithium bromide as an anticonvulsant and a hypnotic In 1871, William Hammond First recorded use of lithium for mania In 1894 Fredrick Used in the prevention of melancholic depression In 1949 John Cade Rediscovered the use of lithium for mania In 1970 FDA Approved the use of lithium for mania
  • 8. MECHANISM OF ACTION BRAIN STRUCTURE NEUROTRANSMITTER MODULATIONS INTRACELLULAR CHANGES MULTIPLE LEVELS OF ACTION OF LITHIUM But the exact mechanism of action of lithium is unknown.
  • 10. PHARMACOKINETICS  Half life – 18 – 24hrs  Lithium is readily absorbed with peak plasma levels occuring 2 – 4 hours after a single oral dose of lithium carbonate  Lithium is distributed rapidly in liver, kidney, muscle, bone and brain.  Elimination is predominantly 95% via kidneys and is influenced by sodium balance  Depletion of sodium can precipitate lithium toxicity
  • 11. DOSAGE  Lithium is available in the form of following preparation:  Lithium carbonate 300mg (Licab)  400mg sustained release tablets (lithosun – SR)  Lithium citrate 300mg/5ml liquid
  • 12. Contd..  The usual range of dose per day in acute mania is 900 – 2100mg given in 2 – 3divided doses.  The treatment is started with after serial lithium estimation is done after a loading dose of 600mg or 900mg of lithium to determine the pharmacokinetics.
  • 13. INDICATIONS ACUTE MANIA PROPHYLAXIS FOR BIPOLAR AND UNIPOLAR MOOD DISORDER SCHIZOAFFECTIVE DISODER BORDERLINE PERSONALITY DISORDER
  • 14. BULLIMIA NERVOSA BINGE DRINKING CLUSTER HEADACHE NEUTROPENIA
  • 15. OTHER INDICATIONS CYCLOTHYMIA IMPULSIVITY AND AGGRESSION TRICHOTILLOMANIA
  • 16. CONTRA INDICATIONS  Cardiovascular disease  Concomitant use of diuretics  Debilitation  Dehydration  Renal diseases, sodium depletion  Pregnancy
  • 18. LEVELS OF LITHIUM TOXICITY  Mild Lithium toxicity – reaches 1.5 mEq/L or higher  Moderate toxicity – 2.0 mEq/L and above which is life threatening in rare cases.  Levels of 3.0 mEq/L and higher are considered as medical emergency.
  • 19. ADVERSE EFFECTS L – Leucocytosis I – Insipidus(Diabetic) T – Tremors, teratogenicity H – Hypothyroidism I – Increased weight gain U – Vomiting(GI disturbances) M - Miscellaneous – ECG changes, Acne
  • 20. SYSTEM 1. NEUROLOGICAL Tremors, motor hyperactivity, muscular weakness, cogwheel rigidity, seizures, neurotoxicity 2. RENAL Polydipsia, polyuria, tubular enlargement, nephritic syndrome 3. CARDIOVASCULAR: T – WAVE depression 4. GATROINTESTINAL Nausea, vomiting, diaarhoea, abdominal pain and metallic taste 5. ENDOCRINE Abnormal thyroid function, goitre, weight gain 7. PREGNANCY & LACTATION Teratogenic possibility Increased incidence of ebstein’s anomaly Secretes in milk and causes toxiity in infant 6. DERMATOLOGICAL Acniform eruptions, populareruptions and exacerbation of psoriasis
  • 22. MEANING Lithium toxicity is another term for a lithium overdose or poisoning Lithium is similar to sodium. In addition, lithium may inhibit the release of monoamines from nerve endings and increase their uptake. TYPES OF POISONING: 1. ACUTE POISONING –voluntary or accidental ingestion in untreated patient 2. ACUTE ON CHRONIC – Voluntary or accidental ingestion in patient currently using lithium 3. CHRONIC OR THERAPEUTIC – progressive lithium toxicity in a patient on lithium therapy.
  • 23. SIGNS & SYMPTOMS  MILD – MODERATE TOXICITY:  Generalized weakness  Fine resting tremor  Mild confusions  MODERATE – SEVERE TOXICITY:  Severe tremors  Muscle fasciculations  Stupor  Seizures  COMA  Signs of cardiovascular collapse
  • 25. SYMPTOMS WITH CHRONIC TOXICITY LEVEL SYMPTOMS 0.5 mEq/L NONE 1.0 mEq/L MILD TREMOR 1.5 mEq/L COARSE TREMOR 2.0 mEq/L HYPERREFLEXIA DYSARTHRIA 2.5 mEq/L MYOCLONIA, ATAXIA,CONFUSION > 3.0 mEq/L DELIRIUM, COMA, SEIZURES
  • 26. COMPLICATIONS  Truncal and gait ataxia  Nystagmus  Hypertonicity  Short term memory deficits  Dementia( rare) PROGNOSIS: Most cases of lithium toxicity result in a favourable outcome; however up to 10% of individuals are with severe toxicity.
  • 27. MANAGEMENT  There is no specific antidote for lithium toxicity  Vital signs monitoring – unusual signs  Lab studies – serum lithium level, electrolytes, RFT and ECG as soon as possible  Gastric lavage or bowel irrigation – if have taken lithium within one hour.  IV fluids – to restore electrolyte balance  Hemodialysis – to remove excess lithium from blood  Medication – if seizure occurs
  • 28. NURSE’S RESPONSIBILITY  Baseline evaluation – ECG, LFT, RFT, urine analysis  Serum lithium levels should be monitored every 3 – 4 days during initial phase of therapy and every 1 – 2 months, weekly monitoring.  Lithium should be monitored at the 12th hour of last dose.  Assess of increased urine output, persistent thirst is important  Assess for therapeutic response
  • 29. PATIENT EDUCATION  Lithium should be taken after meals  Take as directed  Do not discontinue the drug except physician advice.  Thirst and frequent urination may occur  Oral fluid intake of 2 – 3lit/day and normal intake of salt to avoid dehydration.  Educate about side effects and Advice to inform immediately when side effects are notified.  Inform about the regular checkup.
  • 31. REFERENCES  Abou-Saleh MT, Coppen A. The efficacy of low-dose lithium: clinical, psychological and biological correlates. J Psychiatr Res. 1989;23:157–162. doi: 10.1016/0022- 3956(89)90006-X  Bschor T. Lithium in the treatment of major depressive disorder. Drugs. 2014;74:855–62.  Erden A, et al. Lithium intoxication and nephrogenic diabetes insipidus: a case report and review of literature. Int J Gen Med. 2013;6:535–9.  Jaeger A, et al. When should dialysis be performed in lithium poisoning? A kinetic study in 14 cases of lithium poisoning. J Toxicol Clin Toxicol. 1993;31(3):429–47.