The nurse is teaching a group of clients about the mood-stabilizing medications lithium carbonate. Which medications should she instruct the clients to avoid because of the increased risk of lithium toxicity?
A. Antacids
B. Antibiotics
C. Diuretics
D. Hypoglycemic agents
Correct Answer: C. Diuretics
The use of diuretics would cause sodium and water excretion, which would increase the risk of lithium toxicity. Clients taking lithium carbonate should be taught to increase their fluid intake and to maintain normal intake of sodium. Treatment for lithium toxicity is primarily hydration and to stop the drug. Give hydration with normal saline, which will also enhance lithium excretion. Avoid all diuretics. If the patient has severe renal dysfunction or failure, or severely altered mental status, then start with hemodialysis. 20 to 30 mg of propranolol given 2 to 3 times per day may help reduce tremors.
Option A: Antacids are a combination of various compounds with various salts of calcium, magnesium, and aluminum as the active ingredients. The antacids act by neutralizing the acid in the stomach and by inhibiting pepsin, which is a proteolytic enzyme. Each of these cationic salts has a characteristic pharmacological property that determines its clinical use.
Option B: The pharmacology behind antibiotics includes destroying the bacterial cell by either preventing cell reproduction or changing a necessary cellular function or process within the cell. Antimicrobial agents are classically grouped into 2 main categories based on their in vitro effect on bacteria: bactericidal and bacteriostatic.
Option D: FDA approved indications for the use of oral hypoglycemic drugs include type 2 diabetes mellitus. Non-FDA approved indications of oral hypoglycemic drugs, such as metformin, are for the prevention of type 2 diabetes mellitus, treatment of gestational diabetes mellitus, treatment of polycystic ovary syndrome (PCOS) with menstrual irregularities, and prevention of ovarian hyperstimulation syndrome in PCOS patients undergoing intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF), and management of antipsychotic-induced weight gain.