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description Monograph

Lithium: Managing Bipolar Disorder in Childbearing Women

Target Audience: Pharmacy Tech

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schedule 2.00 Contact Hours (0.20 CEUs)
category Disease State Management/Drug Therapy
local_activity Knowledge

Course Overview

Bipolar disorder is a common and serious psychiatric condition, which often has disabling consequences for those afflicted by it. Women have the highest risk of being diagnosed with bipolar or having a recurring episode during pregnancy or within one year of giving birth. During pregnancy and the postpartum period, lithium has been identified as an effective treatment to control symptoms of bipolar disorder and as a prevention of a relapse of symptoms. Fluctuations in serum lithium levels may occur during pregnancy and the postpartum period that can lead to subtherapeutic or supratherapeutic lithium levels. In addition, there are risks with lithium use during pregnancy for the mother and fetus. During the first trimester of pregnancy, there is a potential for congenital malformations due to lithium exposure in utero. There may also be an increased risk of miscarriage from lithium use. The decision to prescribe lithium during pregnancy should be determined by considering the risk factors of using lithium and balancing them with the risk of mood dysregulation and psychosis for the mother. Continuing lithium use during pregnancy requires close monitoring during the perinatal period, including frequent testing of lithium serum levels. Consideration must also be made for mothers who intend to breastfeed.

Learning Objectives

Upon completion of this educational activity, participants should be able to:

  • Describe the potential risks of lithium use during pregnancy
  • Describe the fluctuations in serum lithium levels during pregnancy and the postpartum period, leading to subtherapeutic or supratherapeutic lithium levels.
  • Review the 2023 American College of Obstetricians and Gynecologists guidelines for lithium use during pregnancy and postpartum.
  • Describe the lithium laboratory test monitoring in pregnant and postpartum women who are prescribed lithium

Faculty

Authors & Activity Planners
Douglas Evans, APRN, PMHNP-BC
View Bio +
Douglas Evans is a board certified Psychiatric Mental Health Nurse Practitioner. Douglas has more than a decade of experience working with adult and adolescent mental health populations in Texas and Montana, respectively. He completed his Master of Science in Nursing (PMHNP) at Midwestern State University. Prior to his graduate degree, he earned an Associate of Applied Science in Nursing degree and Bachelor of Science in Nursing, both from Angelo State University. Douglas enjoys cooking, hiking, photography, and spending time with his family.

I. Introduction

II. Bipolar Disorder and Suicidal Ideation in Pregnant Women

III. To Treat or Not to Treat? A Clinical Conundrum

1. Efficacy of Prescribing Lithium in Childbearing Women
2. Potential Risks from Lithium Use During Pregnancy
3. Teratogenic Risks
4. Risk of Spontaneous Preterm Birth
5. Risk of Miscarriage

IV. Managing Lithium’s Teratogenic, Miscarriage, and Suicide Risks

1. Managing Teratogenic Risks
2. Managing the Risk of Miscarriage
3. Managing Suicide Risks

V. Lithium Pharmacokinetics in the Perinatal Period

VI. Laboratory Testing and Monitoring

VII. Lithium Dosing Adjustments During Pregnancy

VIII. Lithium Adverse Events and Poisoning

IX. Lithium and Breastfeeding

X. The American College of Obstetricians and Gynecologists (ACOG) Guidelines

XI. Alternative Drugs During Pregnancy

XII. Lithium Use During Pregnancy Case Reports

1. Case Report I
2. Case Report II
3. Case Report III

XIII. Key Points

XIV. Summary

From August 2, 2023 through August 2, 2026, participants must:

  1. Read the "learning objectives" and "author and planning team disclosures"
  2. Study the section entitled "educational activity"
  3. Complete the Course Test and Evaluation form. The Course Test will be graded automatically. Following successful completion of the Course Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)

Credit for this course will be automatically uploaded to CPE Monitor®.

Faculty Planner Disclosure

The following individuals were involved in developing this activity: Douglas Evans, APRN, PMHNP-BC, Anna S. Smith, MPH, BSN-RN, and Pamela Sardo, PharmD, BS. There are no financial relationships relevant to this activity to report or disclose by any of the individuals involved in the development of this activity.

Unlabeled Use Disclosure

The information provided in this course is general in nature and it is solely designed to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant’s professional practice, including but not limited to patient assessment, diagnosis, treatment and/or health management. Medical and pharmacy practices, rules, and laws vary from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice. Healthcare professionals, including pharmacists and pharmacy technicians, must consult with their employer, healthcare facility, hospital, or other organization, for guidelines, protocols, and procedures they are to follow. The information provided in this course does not replace those guidelines, protocols, and procedures but is for academic purposes only, and this course’s limited purpose is for the completion of continuing education credits. Participants are advised and acknowledge that information related to medications, their administration, dosing, contraindications, adverse reactions, interactions, warnings, precautions, or accepted uses are constantly changing, and any person taking this course understands that such person must make an independent review of medication information prior to any patient assessment, diagnosis, treatment and/or health management. Any discussion of off-label use of any medication, device, or procedure is informational only and such uses are not endorsed hereby. Nothing contained in this course represents the opinions, views, judgments, or conclusions of RxCe.com LLC. RxCe.com LLC is not liable or responsible to any person for any inaccuracy, error, or omission with respect to this course, or course material.

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Accreditation

In support of improving patient care, RxCE.com is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

PTCB Recognition

RxCe.com, LLC, offers pharmacy technician continuing education courses for PTCB recertification. Pharmacy technician courses are indicated both in the Target Audience description and the ACPE UAN which will end with a "T".