Overview

1. Enhances serotonin and/or GABA function.

Nursing Points

General

1. Most commonly used = Lithium  
   1. Increases serotonin and decreases norepinephrine
   2. Used for Bipolar Disorder

Nursing Considerations

1. Lithium
   1. Monitor therapeutic level
      1. 0.6-1.2 mEq/L
      2. Frequency per protocol
         1. More often after initiation
         2. Then monthly
      3. Best drawn in morning, approximately 12 hours since last dose
   2. Caution in Pregnancy
   3. Things that can cause toxicity:
      1. Dehydration
      2. ETOH
      3. Caffeine
      4. Diuretics
   4. Promote appropriate fluid balance

Toxicity

1. Lithium toxicity
   1. Can be mild, moderate, or severe
   2. Kidneys cannot excrete it; builds up
   3. Usually when serum levels are 1.5 – 2 mEq/L
   4. Know symptoms
      1. N/V/D
      2. Weakness
      3. Tremor
      4. Seizures
      5. Hallucinations
   5. Interventions
      1. Assess patient
         1. Full set of VS
         2. EKG
         3. LOC
      2. Hold dose, notify Provider
      3. Obtain labs: CBC, lithium level, CMP/BMP
      4. Initiate suicide precautions