| 单词 | lithane | |||||||||||
| 释义 | Lithane
Lithanelithium carbonatelithium citratePharmacologic class: Miscellaneous CNS drug Therapeutic class: Antimanic drug Pregnancy risk category D FDA Box Warning• Lithium toxicity is closely related to lithium blood level and can occur at doses close to therapeutic levels. Before starting therapy, ensure that resources for prompt, accurate blood lithium testing are available. ActionUnknown. Thought to disrupt sodium exchange and transport in nerves and muscles and control reuptake of neurotransmitters. AvailabilityCapsules: 150 mg, 300 mg, 600 mg Syrup (citrate): 300 mg (8 mEq lithium)/5 ml Tablets: 300 mg Tablets (extended-release): 300 mg, 450 mg Tablets (slow-release): 300 mg Indications and dosages➣ Manic episodes of bipolar disorder Adults and children ages 12 and older: 900 to 1,800 mg P.O. daily in divided doses (for example, 300 to 600 mg t.i.d. or 450 to 900 mg b.i.d. of controlled- or slow-release form) to achieve blood level of 1 to 1.5 mEq/L; measure blood level twice weekly until patient stabilizes. Maintenance dosage is 900 to 1,200 mg/day in divided doses (forexample, 300 to 400 mg t.i.d. or 450 to 600 mg b.i.d. of controlled- or slow-release form) to maintain blood level of 0.6 to 1.2 mEq/L. Monitor blood level at least q 2 months. Dosage adjustment• Impaired renal function • Elderly patients Off-label uses• Acute manic episodes in children • Corticosteroid-induced psychosis • Neutropenia secondary to antineoplastic therapy • Tardive dyskinesia • Alcoholism • Bulimia ContraindicationsNone PrecautionsUse cautiously in: • hepatic or thyroid disease, severe cardiovascular or renal disease, diabetes mellitus, seizure disorders, systemic infections, brain trauma, organic brain syndrome, urinary retention, severe sodium depletion • elderly patients • pregnant or breastfeeding patients • children (safety not established). AdministrationSee Be aware that dosages are individualized according to lithium blood level and response. • Give with food or milk to minimize GI upset. • Make sure patient swallows slow-release tablet whole without chewing or crushing. • When switching patient from immediate-release to controlled- or slow-release form, give same total daily dosage.  Adverse reactionsCNS: dizziness, drowsiness, headache, tremor, tics, EEG changes, ataxia, choreoathetotic movements, abnormal tongue movements, extrapyramidal reactions, cogwheel rigidity, blackout spells, psychomotor retardation, slow mental functioning, slurred speech, startled response, restlessness, agitation, confusion, hallucinations, poor memory, worsening of organic brain syndrome, stupor, coma, epileptiform seizures CV: bradycardia, ECG changes, hypotension, sinus node dysfunction with severe bradycardia and syncope, arrhythmias, peripheral circulatory collapse EENT: blurred vision, nystagmus, tinnitus GI: nausea, vomiting, diarrhea, abdominal pain, fecal incontinence, gastritis, flatulence, dyspepsia, anorexia, increased salivation, salivary gland swelling, dry mouth GU: urinary incontinence, glycosuria, albuminuria, erectile or other sexual dysfunction, polyuria or other signs of nephrogenic diabetes insipidus, oliguria Hematologic: leukocytosis Metabolic: hypothyroidism or hyperthyroidism, goiter, hyperglycemia, hypercalcemia, hyponatremia, hyperparathyroidism Musculoskeletal: swollen or painful joints, muscle weakness, muscle fasciculations and twitching, clonic arm or leg movements, hypertonicity, hyperactive deep tendon reflexes, polyarthralgia Skin: dry thin hair, alopecia, diminished or absent skin sensations, chronic folliculitis, eczema with dry skin, new onset or exacerbation of psoriasis, pruritus (with or without rash), cutaneous ulcers, angioedema Other: altered, metallic, or salty taste; dental caries; weight gain; excessive thirst; polydipsia; fever; edema of lips, ankles, and wrists InteractionsDrug-drug. Acetazolamide, alkalinizing agents (such as sodium bicarbonate), urea, verapamil, xanthines: decreased lithium blood level Calcium channel blockers, carbamazepine, haloperidol, methyldopa: increased risk of neurotoxicity Diuretics: increased sodium loss, increased risk of lithium toxicity Fluoxetine, loop diuretics, metronidazole, nonsteroidal anti-inflammatory drugs: increased risk of lithium toxicity Iodide salts: synergistic effects, increased risk of hypothyroidism Neuromuscular blockers: prolonged neuromuscular blockade, severe respiratory depression Phenothiazines: decreased phenothiazine blood level or increased lithium blood level, greater risk of neurotoxicity Selective serotonin reuptake inhibitors: increased risk of tremor, confusion, dizziness, agitation, and diarrhea Sympathomimetics: decreased pressor sensitivity Tricyclic antidepressants: increased antidepressant effects Drug-diagnostic tests. Albumin, creatinine, sodium, thyroxine, triiodothyronine: decreased levels Calcium, glucose,131I uptake, white blood cells (WBCs): increased levels Drug-food. Caffeine-containing foods and beverages: decreased lithium blood level and efficacy Drug-herbs. Caffeine-containing herbs (cola nut, guarana, yerba maté): decreased lithium blood level and efficacy Patient monitoring• Obtain baseline ECG and electrolyte levels before and periodically during therapy. • Assess neurologic and psychiatric status. Institute safety measures as needed to prevent injury. • Monitor lithium blood level, WBC count, and thyroid and kidney function tests. • Assess cardiovascular status regularly. • Monitor fluid intake and output. Watch for edema and weight gain. Patient teaching• Advise patient to take with food or milk to minimize GI upset. • Instruct patient to swallow slow-release tablet whole without chewing or crushing. • Tell patient that beneficial effects may take 1 to 3 weeks to appear. • Advise patient to limit foods and beverages containing caffeine, because they may interfere with drug action. • Tell patient to maintain adequate fluid intake. • Explain that drug may cause adverse CNS effects. Advise patient to avoid activities requiring mental alertness until effects are known. See Emphasize importance of having regular blood tests, to help detect and prevent serious adverse reactions. • Instruct patient to carry appropriate medical identification at all times. • As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above. lithium(lith-ee-um) lithium,Carbolith(trade name),Lithane(trade name),Lithmax(trade name),Lithobid(trade name)ClassificationTherapeutic: mood stabilizersIndicationsActionTherapeutic effectsPharmacokineticsTime/action profile (antimanic effects)
Contraindications/PrecautionsAdverse Reactions/Side EffectsCentral nervous system
Ear, Eye, Nose, Throat
Cardiovascular
Gastrointestinal
Genitourinary
Dermatologic
Endocrinologic
Fluid and Electrolyte
Hematologic
Metabolic
Musculoskeletal
Neurologic
InteractionsDrug-Drug interactionMay prolong the action of neuromuscular blocking agents.↑ risk of neurologic toxicity with haloperidol.Diuretics, methyldopa, probenecid, fluoxetine, and NSAIDs may ↑ risk of toxicity.Blood levels may be ↑ by ACE inhibitors.Lithium may ↓effects of chlorpromazine.Chlorpromazine may mask early signs of lithium toxicity.Hypothyroid effects may be additive with potassium iodide or antithyroid agents.Aminophylline, phenothiazines, and drugs containing large amounts of sodium ↑ renal elimination and ↓ effectiveness.Psyllium can ↓ lithium levels.Caffeine-containing herbs (cola nut, guarana, mate, tea, coffee) may ↓ lithium serum levels and efficacy.Large changes in sodium intake may alter the renal elimination of lithium. ↑ sodium intake will ↑ renal excretion.Route/DosagePrecise dosing is based on serum lithium levels. 300 mg lithium carbonate contains 8–12 mEq lithiumAvailability (generic available)Nursing implicationsNursing assessment
Potential Nursing DiagnosesDisturbed thought process (Indications)Ineffective coping (Indications) Imbalanced nutrition: risk for more than body requirements (Side Effects) Implementation
Patient/Family Teaching
Evaluation/Desired Outcomes
Lithium (Lithane, Lithromate)Lithane
Synonyms for Lithane
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