Lithium is commonly used to treat mania associated with bipolar disorder. It works by regulating manic episodes. Common side effects include tremors, nausea, and thinning hair. Lithium toxicity can occur if lithium levels in the blood become too high and symptoms include diarrhea, vomiting, blurred vision, and irregular heartbeat. Nurses play an important role in monitoring lithium levels and educating patients to ensure proper dosing and prevent toxicity.

1. LITHIUM (( AntiManic Drug )) Done By: Wedad Al-Harbi

2. Objectives: *Definition and causes of Mania. *Some treatments for mania. *Definition of lithium. .*Lithium indications *Side effects of lithium. *Dose and overdose. * Lithium toxicity. *Treatment for lithium toxicity. *Nursing roles for patient taking lithium.

3. Definition of Mania: Mania is an abnormally elated mental state, typically characterized by feelings of euphoria, lack of inhibitions, racing thoughts, diminished need for sleep, talkativeness, risk taking, and irritability. In extreme cases, mania can induce hallucinations and other psychotic symptoms.

4. Causes: Mania can be induced by the use or abuse of stimulant drugs such as cocaine and amphetamines. It is also the predominant feature of bipolar disorder, or manic depression, an affective mental illness that causes radical emotional changes and mood swings.

5. Treatment: Mania is primarily treated with drugs. The following mood-stabilizing agents are commonly prescribed to regulate manic episodes: *Lithium (Cibalith-S, Eskalith, (Lithane *Carbamazepine(Tegretol, Atretol) *Valproate(divalproex sodium, or Depakote; valproic acid, or Depakene

6. What is lithium? is one of the oldest and most frequently prescribed drugs available for the treatment of mania. Because the drug takes four to seven days to reach a therapeutic level in the bloodstream, it is sometimes prescribed in conjunction with neuroleptics (antipsychotic drugs) and/or benzodiazepines (tranquilizers) to provide more immediate relief of mania.

7. Lithium indications: healthcare providers may also recommend lithium for something other than bipolar disorder. This is called an "off-label" use. Examples of off-label lithium uses include the treatment of: Agitation that is not associated with bipolar disorder Depression Graves' disease (a form of hyperthyroidism) Migraine headaches or cluster headaches Neutropenia (low levels of neutrophils, a type of white blood cells) that is caused by chemotherapy or other medications Syndrome of inappropriate antidiuretic hormone secretion (SIADH), a condition that affects sodium levels in the blood.

8. Lithium side effects: Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat

9. Serious side effects: extreme thirst, urinating more or less than usual; weakness, fever, feeling restless or confused, eye pain and vision problems; restless muscle movements in your eyes, tongue, jaw, or neck; pain, cold feeling, or discoloration in your fingers or toes; feeling light-headed, fainting, slow heart rate; hallucinations, seizure (blackout or convulsions); fever with muscle stiffness, sweating, fast or uneven heartbeats; or early signs of lithium toxicity, such as nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears.

10. Less serious side effects: mild tremor of the hands; weakness, lack of coordination; mild nausea, vomiting, loss of appetite, stomach pain or upset; thinning or drying of the hair; or itching skin

11. Maintenance dose: The usual recommended dose for acute mania is1800 milligrams/day in divided doses to achieve the desired serum level of 1 to 1.5 millimole/liter Doses should be individualized to appropriate serum level and patient response. Until the serum level and the patient clinical condition are stable , lithium concentration should be determined twice weekly.

12. :Onset and Duration Onset- Initial Response Mania, oral: 7 to 14 days

13. Lithium toxicity: They are easy to identify, but fatal to ignore. There is a world of difference between side effects and lithium toxicity - too much lithium in the blood can kill you. Don't ignore any of these signs! Contact the doctor immediately! Too much lithium can lead to coma, brain damage or death.

14. Signs of lithium overdose or poisoning are: 1. Persistent diarrhea. 2. Vomiting or severe nausea. 3. Coarse trembling of hands or legs. 4. Frequent muscle twitching such as pronounced jerking of arms or legs. 5. Blurred vision. 6. Marked dizziness. 7. Difficulty walking. 8. Slurred speech. 9. Irregular heart beat. 10. Swelling of the feet or lower legs.

15. Treatment for an Overdose: The treatment for an overdose on lithium will also vary, depending on when the overdose was taken and its severity. If the overdose was recent, the healthcare provider may use certain medicines or place a tube into the stomach to "pump the stomach." Once the drug has been absorbed into the body, dialysis may be helpful in cases of severe overdose. In these cases, treatment typically involves supportive care, which consists of treating the symptoms that occur as a result of the overdose. For example, supportive treatment options may include: Fluids through an intravenous line (IV) Other treatments based on the complications that occur.

16. Nursing Role: In order to prevent Lithium toxicity and decrease the risk, nurse should consider the following roles: *Follow the lithium dosing instructions carefully, and do not give more than prescribed. *Instruct the patient to drink plenty of fluids, as being dehydrated increases the risk of lithium toxicity and avoid caffeinated drinks like coffee and some sodas because of their diuretic effect. *ALWAYS take the blood tests exactly when the doctor advises. *PREPARE correctly for the blood tests. This means that for 4-5 days before testing don't forget any doses and don't give any extra doses. Also, blood test should be done in the morning as close as possible to within 12 hours of your last dose *Make sure to have the patient lithium levels checked regularly. *Contact doctor if notice any symptoms of toxicity.

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