PMHNP Review (Georgette)
Lithium Level - normal ANS: 0.6-1.2
Lithium Toxicity ANS: >1.5
Narrow therapeutic window
Lithium Gold Standard ANS: Manic Episodes
has some slight effects on depressive symptoms
Long-standing history
Lithium has evidence for ANS: Reducing suicidal ideation
Lithium for Bipolar ANS: Is neuroprotective. The neuroprotective effects of lithium are attributed to its
ability to regulate several biological pathways and processes:
Neuroprotective ANS: has properties that help protect neurons (nerve cells) from damage,
degeneration, or death. This effect is significant in the context of neurodegenerative diseases, mood
disorders, and other conditions that involve neuronal injury.
Baseline Labs for Lithium ANS: Thyroid Panel (TSH)
Serum Creatinine (.06-1.2)
Blood Urea Nitrogen (BUN) 10-20
Pregnancy test (HCG) - all females 12-51 on psychotropics
EKG 50+
Side effects of Lithium ANS: Endo (wt gain, hypothyroid)
,CNS (fine hand tremor, fatigue, brain fog, HA, nystagmus)
Dermatological (maculopapular rash, acne, pruritis)
GI (Diarrhea, vomiting, cramps, anorexia)
Renal (Diabetes insipidus, polyuria/polydypsia, edema, tubular changes in the kidneys)
Cardiac (T wave inversion, dysrhythmia)
Hematologic (leukocytosis - increased WBC)
Drugs that reduce renal clearance ANS: Kidney disease, reduces renal clearance
NSAIDS (Ibuprophen, Indocin)
Thiazides (HCTZ)
Ace Inhibitors (Lisinopril)
these drugs cause an increase in serum concentration of the drugs excreted by the kidney such as
Lithium
Lithium excretion ANS: Kidney - impacted by drugs that reduce renal clearance
Lithium toxicity ANS: Severe
Nausea, vomiting, diarrhea
Confusion, convulsions
drowsiness, blurred vision
slurred speech
Muscle weakness
Heart palpitations
Coarse hand tremors
Ataxia (unstable gait)
,Treatment for Lithium Toxicity ANS: First: DC Lithium, Check serum lithium levels
Management secondary: Vital signs, ekg,
Therapeutic effect of Lithium ANS: Narrow therapeutic window
Draw at trough level, 12 hours post dose
Level at 1.2 and above is at risk for toxicity
Lithium and pregnancy ANS: Category D
Lactation category L3
Elderly and psychotropics ANS: More sensitive due to
decreased intracellular water
Protien binding
Low muscle mass
decreased metabolism
increased body fat
Hypertensive Crisis ANS: Occurs when MAOI (isocarboxazid, phenelzine, selegiline, and tranylcypromine)
are taken with foods containing tyramine
When MAO is inhibited (like in MAOI) tyramine exerts a strong vasopressor effect, stimulating the
release of catecholamines, epi and nor eip, which increase BP and HR
Tyramine ANS: Precursor to Norepinephrine
MAOIs ANS: Isocarboxazid
, Phenelzine
Selegiline
Tranylcypromine
Foods containing Tyramine ANS: Fermented soy products
Yeast extracts
Chocolate and cocoa
Vinegar-based foods and condiments
Alcohol - wine, non alcoholic beer, cola
Bananas, figs, raisins,
Fava beans, broad beans
Overripe avacado - fruits and vegetables
Pickled foods, sourkraut
Smoked processed and cured meats
Liver
Smoked for pickled fish
Hypertensive Crisis S/S ANS: BP 180/120 or greater
Elevated BP
Sudden explosive-like headache, occipital region
Facial flushing
Palpitations
Pupillary Dilation
Diaphoresis
Fever
Lithium Level - normal ANS: 0.6-1.2
Lithium Toxicity ANS: >1.5
Narrow therapeutic window
Lithium Gold Standard ANS: Manic Episodes
has some slight effects on depressive symptoms
Long-standing history
Lithium has evidence for ANS: Reducing suicidal ideation
Lithium for Bipolar ANS: Is neuroprotective. The neuroprotective effects of lithium are attributed to its
ability to regulate several biological pathways and processes:
Neuroprotective ANS: has properties that help protect neurons (nerve cells) from damage,
degeneration, or death. This effect is significant in the context of neurodegenerative diseases, mood
disorders, and other conditions that involve neuronal injury.
Baseline Labs for Lithium ANS: Thyroid Panel (TSH)
Serum Creatinine (.06-1.2)
Blood Urea Nitrogen (BUN) 10-20
Pregnancy test (HCG) - all females 12-51 on psychotropics
EKG 50+
Side effects of Lithium ANS: Endo (wt gain, hypothyroid)
,CNS (fine hand tremor, fatigue, brain fog, HA, nystagmus)
Dermatological (maculopapular rash, acne, pruritis)
GI (Diarrhea, vomiting, cramps, anorexia)
Renal (Diabetes insipidus, polyuria/polydypsia, edema, tubular changes in the kidneys)
Cardiac (T wave inversion, dysrhythmia)
Hematologic (leukocytosis - increased WBC)
Drugs that reduce renal clearance ANS: Kidney disease, reduces renal clearance
NSAIDS (Ibuprophen, Indocin)
Thiazides (HCTZ)
Ace Inhibitors (Lisinopril)
these drugs cause an increase in serum concentration of the drugs excreted by the kidney such as
Lithium
Lithium excretion ANS: Kidney - impacted by drugs that reduce renal clearance
Lithium toxicity ANS: Severe
Nausea, vomiting, diarrhea
Confusion, convulsions
drowsiness, blurred vision
slurred speech
Muscle weakness
Heart palpitations
Coarse hand tremors
Ataxia (unstable gait)
,Treatment for Lithium Toxicity ANS: First: DC Lithium, Check serum lithium levels
Management secondary: Vital signs, ekg,
Therapeutic effect of Lithium ANS: Narrow therapeutic window
Draw at trough level, 12 hours post dose
Level at 1.2 and above is at risk for toxicity
Lithium and pregnancy ANS: Category D
Lactation category L3
Elderly and psychotropics ANS: More sensitive due to
decreased intracellular water
Protien binding
Low muscle mass
decreased metabolism
increased body fat
Hypertensive Crisis ANS: Occurs when MAOI (isocarboxazid, phenelzine, selegiline, and tranylcypromine)
are taken with foods containing tyramine
When MAO is inhibited (like in MAOI) tyramine exerts a strong vasopressor effect, stimulating the
release of catecholamines, epi and nor eip, which increase BP and HR
Tyramine ANS: Precursor to Norepinephrine
MAOIs ANS: Isocarboxazid
, Phenelzine
Selegiline
Tranylcypromine
Foods containing Tyramine ANS: Fermented soy products
Yeast extracts
Chocolate and cocoa
Vinegar-based foods and condiments
Alcohol - wine, non alcoholic beer, cola
Bananas, figs, raisins,
Fava beans, broad beans
Overripe avacado - fruits and vegetables
Pickled foods, sourkraut
Smoked processed and cured meats
Liver
Smoked for pickled fish
Hypertensive Crisis S/S ANS: BP 180/120 or greater
Elevated BP
Sudden explosive-like headache, occipital region
Facial flushing
Palpitations
Pupillary Dilation
Diaphoresis
Fever
