Bipolar management

Question 1

maintenance therapy for bipolar

Answer 1

lithium carbonate

Question 2

why does lithium need monitoring

Answer 2

narrow therapeutic window

Question 3

when can a patient become lithium toxic and why

Answer 3

when dehydrated - lithium is excreted by the kidneys and behaves similarly to Na
dehydration = retain more na thus more lithium

Question 4

tests done prior to initiation of lithium

Answer 4

U+E
thyroid
ECG

Question 5

tests done during initiation of lithium

Answer 5

lithium level 12 hours after last dose then every 5 days until therapeutic range reached

Question 6

tests done 3 monthly

Answer 6

lithium level

U+E

Question 7

tests done 6 monthly

Answer 7

thyroid function

Question 8

if unwell and on lithium, what tests are done

Answer 8

lithium level

U+E

Question 9

side effects of lithium

Answer 9

dry mouth/strange taste
polydipsia/polyuria
decreased renal function
tremor
hypothyroid
weight gain
ankle oedema 
nephrogenic diabetes insipidus

Question 10

if patient on lithium develops hypothyroid but has good response to lithium, should it be stopped?

Answer 10

no - give thyroxine

Question 11

drug interactions with lithium

Answer 11

think renal
diuretics (thiazide are better than loop)
ACE and ARBs
NSAIDs

Question 12

symptoms of lithium toxicity

Answer 12

GI upset
blurred vision
drowsy
coarse tremor
ataxia
convulsions

Question 13

treating mania/hypomania

Answer 13

stop anti-depressant

offer anti-psychotic

Question 14

treating bipolar depression

Answer 14

if on no other medication - fluoxetine and olanzapine (or quetiapine alone)