Bi Flashcards
When was lithium first used and approved in the United States?
thium was first used in 1949 and approved in 1972 in the United States for the treatment of acute mania and maintenance therapy.
What is the proposed mechanism of action for lithium?
There is no unified theory for lithium’s mechanism of action, but chronic administration may modulate gene expression and have neuroprotective effects.
What are the key properties of lithium?
-a monovalent cation.
-rapidly absorbed and widely distributed.
-does not bind to proteins.
-not metabolized
-excreted unchanged in urine and other body fluids.
What are the key properties of lithium?
-a monovalent cation.
-rapidly absorbed and widely distributed.
-does not bind to proteins.
-not metabolized
-excreted unchanged in urine and other body fluids.
What is lithium considered a first-line treatment for?
Acute mania
Acute bipolar depression
Maintenance treatment of bipolar I and II disorders
What is the reported response rate for lithium in treating acute manic or hypomanic episodes?
Early studies reported up to a 78% response rate, but more recent studies suggest a slower onset of action and moderate effectiveness compared to other agents.
How effective is lithium for bipolar depression?
Lithium has efficacy in bipolar depression, but it may take 6 to 8 weeks to show antidepressant effects
What is lithium’s role in the maintenance phase of bipolar disorder?
Lithium helps prevent both manic and depressive episodes and reduces the risk of relapse.
How does lithium affect suicide risk in bipolar disorder?
Lithium reduces the risk of suicide in patients with bipolar disorder.
How can relapse be reduced when using lithium?
Relapse can be reduced by combining lithium with other medications, such as:
• Divalproex sodium
• Carbamazepine
• Lamotrigine
• Antipsychotics
What can happen with abrupt discontinuation or noncompliance with lithium?
Abrupt discontinuation or noncompliance increases the risk of relapse and worsens outcomes.
What are the three categories of adverse effects related to lithium use?
- Early therapy effects: Generally innocuous and transient.
- Long-term effects: Not dose-related.
- Toxic effects: Occur with high serum concentrations.
What are the common initial side effects of lithium?
• Gastrointestinal (GI) side effects (e.g., nausea, diarrhea).
• Central nervous system (CNS) side effects (e.g., dizziness, sedation).
These are often dose-related and worse at peak serum concentrations (1–2 hours post-dose
How can adverse effects of lithium be minimized?
• Lowering the dose.
• Taking doses with food.
• Using extended-release products.
• Trying once-daily dosing at bedtime
How can diarrhea caused by lithium be managed?
• Switch from tablet or capsule formulation to liquid formulation.
• Diarrhea caused by lithium is often osmotic, so switching to a formulation that clears the gut quickly can reduce symptoms.
What are the two types of tremors associated with lithium use?
- Benign fine hand tremor: Common and mild.
- Coarse hand tremor: May indicate lithium toxicity
What are strategies to reduce a benign fine hand tremor caused by lithium?
• Switch to a long-acting preparation.
• Lower the dose if possible.
• Add a β-adrenergic antagonist (e.g., propranolol 20–120 mg/day).
What renal-related conditions can occur in patients treated with lithium?
• Polydipsia (excessive thirst) and polyuria (excessive urination).
• Nephrogenic diabetes insipidus (DI): Occurs in 30–50% of patients soon after starting lithium
How common is persistent nephrogenic diabetes insipidus (DI) in lithium-treated patients?
About 10–25% of patients on continued lithium treatment develop persistent nephrogenic DI.
Is nephrogenic diabetes insipidus caused by lithium reversible?
Yes, it is typically reversible upon discontinuation of lithium.
Are there other renal effects associated with lithium?
Other nonspecific renal effects may occur, but no clear causality has been established for many of these findings
Are there other renal effects associated with lithium?
Other nonspecific renal effects may occur, but no clear causality has been established for many of these findings
What endocrine condition can occur in patients treated with lithium?
Hypothyroidism, which occurs more frequently in women than in men
How is lithium-induced hypothyroidism managed?
By adding exogenous thyroid hormone (e.g., levothyroxine) to the patient’s treatment regimen.
What happens to the need for exogenous thyroid hormone if lithium is discontinued?
The need for exogenous thyroid hormone should be reassessed, as hypothyroidism caused by lithium can be reversible
What happens to the need for exogenous thyroid hormone if lithium is discontinued?
The need for exogenous thyroid hormone should be reassessed, as hypothyroidism caused by lithium can be reversible
