Lithium
USE: for mania in bipolar

MECHANISM: modulates Na+ of nerve & muscle cells => reduces manic episodes. It's highly attracted to thyroid gland and thus causes hypothyroidism.

SIDE EFFECTS:

• Vulnerable population:
•  Women: effective birth controls => D category for pregnancy & lactating
• Elderly: lower dosage
• Adolescents: FDA approved for >12 y/o
• Organs:
• Heart - arrhythmias & hypotension
• Neuro - impaired thought process & drowsiness
• Skin - hives, acne, alopecia, eruption of psoriasis

MONITORING:

1. Renal (BUN, Cr, GFR q3 mo.)-----Need to drink lots of water due to risk of nephrogenic diabetes insipidus
2. Thyroid (TSH) ----Similar to Iodine, Lithium as a chemical element is also attracted to thyroid
3. Monitor blood level ---- Narrow therapeutic index, Toxicity is closely related to serum lithium concentrations and may occur at dosages close to therapeutic levels; monitor therapy by measuring serum lithium

Lithium:
Metabolism: Not metabolized (Therefore, not worried about Liver function).----it cannot be further broken down, kinda similar to Sodium
Elimination: Renal (Check renal function)