Bipolar Disorder (including lithium TDM)

Question 1

What drugs can be given for manic symptoms associated with BP disorder?

Answer 1

Haloperidol
Lithium
Quetiapine
Risperidone
Olanzapine

Question 2

What monitoring requirements are needed for lithium, and how often are they measured?

Answer 2

Measured every 6 months:
Thyroid function
Ca2+ levels
BMI
ECG in CV patients
Renal function - eGFR
U+E

Question 3

When are lithium serum conc. levels measured?

Answer 3

12h post dose
1 week after starting treatment
1 week after dose changes
Weekly until lithium levels are stable

Question 4

What are the symptoms of lithium toxicity?

Answer 4

N+V
Seizures
Lethargy
Blurred vision
Uncontrolled movements
Tinnitus
Tremor

ALWAYS REFER

Question 5

What serum conc. of lithium is considered to be toxic?

Answer 5

> 1.5mmol/L

Question 6

What is the therapeutic range of lithium?

Answer 6

0.6-0.8mmol/L

Question 7

What should a patient on lithium always carry with them?

Answer 7

A lithium card

Question 8

What drug classes can cause lithium toxicity, and should hence be avoided?

Answer 8

NSAIDs
ACEi - can cause renal failure
Diuretics (thiazides) - can cause renal failure

Question 9

Which diuretic is the safest to administer with lithium?

Answer 9

Loop diuretics (e.g. furosemide, bumetanide)

Question 10

Why should patients taking lithium always stay hydrated?

Answer 10

To avoid lithium toxicity associated with depleted sodium levels from diarrhoea/vomiting

Question 11

Why can lithium cause hypothyroidism?

Answer 11

Because lithium inhibits thyroidal iodine uptake

Question 12

What are the symptoms of hypothyroidism?

Answer 12

Weight gain
Constipation
Fatigue
Slow muscle movements
Muscle cramps

Question 13

Can you stop lithium abruptly?

Answer 13

No, always refer if toxicity present