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MRCPSYCH Paper B _ Mainly general Adult (mentor&more) > Lithium - 1 > Flashcards

Lithium - 1 Flashcards

1
Q

Lithium mechanism of action at neural level?

A

reduces excitatory (dopamine and glutamate)
increases inhibitory (GABA) neurotransmission
increases serotonin transmission by increasing serotonin synthesis, uptake, and release

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2
Q

neuroprotective action of lithium?

A

Lithium may reduce oxidative stress and increase protective proteins, such as brain-derived neurotrophic factor and B-cell lymphoma 2

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3
Q

Does Lithium reduce suicidality?

A

Yes by 80%

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4
Q

Why lithium is better for prophylaxis rather than in acute mania?

A

Because it takes a week to show effect

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5
Q

effect of lithium on mania as prophylactic?

A
  • reduces severity
    -reduces the number of relapses
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6
Q

does lithium have different effect on manic bipolar or the depressive episodes?

A

manic episodes

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7
Q

Lithium protects against antidepressive induced hypomania. True or false

A

True

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8
Q

Lithium is shown to be effective as augmentation in unipolar depression. True or false?

A

True!!!again!!!

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9
Q

Non- bipolar situation where lithium has been used?

A

-augmentation Rx in unipolar depression
-Aggressive or self-mutilating behaviours
-Steroid-induced psychosis
-To raise WBC in clozapine users

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10
Q

Pre-Prescription test in Lithium therapy?

A

-ECG (cardiology)
-U&E (kidney)
-TFT (Thyroid)

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11
Q

Extra pre-prescription test suggested by BNF?

A
  • BMI
    +
    -Full blood count
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12
Q

Lithium in women childbearing age?

A

-Advised reg. contraception
-informed about toxicity

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13
Q

what dosing frequency is preferred for lithium?

A

once daily

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14
Q

when is usually lithium given?

A

at night

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15
Q

Example of lithium preparation?

A

Priadel
Liskonum

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16
Q

What is the risk of abrupt discont. of lithium?

A

R e l a p s e

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17
Q

Minimum duration for tapering lithium?

A

at least 4 week
at least 1 month
at least over 30 days

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18
Q

Preferred duration for lithium discontinuation?

A

3 months
12 weeks
90 days
a quarter of year
over one season

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19
Q

Inadequate Lithium monitoring is rare. True or false?

A

False.
It is common

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20
Q

BNF suggestion for Lithium level monitoring

A

1- Weekly until dose is stabilised (upon initialising or changing dose)
2- Every 3 months for the first year
3-Every 6 months

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21
Q

BNF Suggestion for more frequent lithium monitoring?

A

->65 years old
-co-drugs with potential interaction
-Impaired Renal & Thyroid
-Raised Calcium or other complications
-Poor symptom control
-Poor adherence
-Last lithium serum level .8 mmol/L or more

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22
Q

BNF suggestion for extra items to be monitored beside lithium level?

A

BMI
Thyroid function test
Serum electruid ]====> every 6 months
eGFR

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23
Q

How long after last dose, lithium level should be taken?

A

12 hours later
(10-14 hours is still reasonable)

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24
Q

BNF suggested a therapeutic lithium level?

A
  • 0.4-1 mmol/L
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25
BNF suggested therapeutic lithium level for maintenace and elderly?
Around 0.4 mmol/L
26
BNF suggested a therapeutic lithium level of 0.8-1 mmol/L.
- Acute mania -Hx of Relapse -Sub-syndromal symptoms
27
Maudsley Suggests the **minimum** adequate plasma level of lithium for prophylaxis.
0.4 mmol/L
28
Maudsley Suggestes the **Optimal** adequate plasma level of lithium for prophylaxis?
0.6 - 1.2 mmol/L
29
Maudsley Suggestes the **Protective** plasma level of lithium against mania (prophylaxis?
>0.75 mmol/L
30
Maudsley Suggestes the **TARGET** adequate plasma level of lithium for prophylaxis?
0.6 - 0.75 mmol/L
31
0.4 mmol/L
Maudsley Suggests the **minimum** adequate plasma level of lithium for prophylaxis.
32
0.6 - 1.2 mmol/L
Maudsley Suggestes the **Optimal** adequate plasma level of lithium for prophylaxis?
33
>0.75 mmol/L
Maudsley Suggestes the **Protective** plasma level of lithium against mania (prophylaxis?
34
0.6 - 0.75 mmol/L
Maudsley Suggestes the **TARGET** adequate plasma level of lithium for prophylaxis?
35
what medication class can mess up lithium level?
NSAIDS ACE inhibitors Diuretics
36
Risk F a c t o r s to cause lithium toxicity?
- Drug interactions -Fever -Infections -Reduced circulating volume -Dehydration -Nephrogenic Diabetic Insepidus
37
Drugs that increase Lithium Level?
NSAIDs (Aspirin) COX-2 inhibitors (Celecoxib) Thiazide (bendroflumethiazide) ACE inhibitors (Captopril, ramipril)
38
Drugs that have no effect on lithium but work in kiney?
Loop diuretics (Furosemide, bumetanide, and torsemide)
39
Division of lithium toxicity
GIT Neurology
40
GIT features of lithium toxicity
Nausea Vomitting Diarrhoea Abd. cramps
41
Neurology related features of lithium toxicity?
- Coarse Tremor -Seizure - Dystonia - Ataxia -Nystagmus -Hyperreflexia -confusion
42
What scale is used to measure lithium toxicity?
AMDISEN
43
Ratings on MDISEN = score 0
No signs or symptoms?
44
Ratings on MDISEN = score 1
Mild symptoms Nausea Vomiting Tremor Hyperreflexia Agitation Weakness Ataxia
45
Ratings on MDISEN = score 2
Moderate
46
Ratings on MDISEN = score 3
Severe Cardiovascular Coma Seizure Myoclonus
47
what is metabolite of lithium called?
Lithium has no metabolite It is not metabolized.
48
Does Lithium bind to any protiens?
no it roams free
49
what congenital disease is thought to be associated with Lithium
Ebstein's (had not held to be true recently)
50
what is Ebstein's?
Prolapse of the tricuspid valve into the right ventricle
51
incidence of Ebstein's?
1:20'000 of general population
52
mnemonic of Lithium contraindications?
BAC LUC
53
Contraindications for lithium?
BAC LUC - Brugada disease -Addison's disease -Cardiovascular (arrythmia) -Low sodium -Untreated hypothyroidism -Clinical signif. renal failure
54
A patient on lithium comes in with nausea...what do you think caused it?
it might be related to the peak of the dose...divide the dose into two or three to reduce the peak
55
prognosis for lithium induced nausea
may diminish over time
56
what if lithium - induced - nausea was accompanied by vomitting?
it is probably due to toxicity not just a side effect
57
what can cause lithium-induced polydipsia + polyurea?
ADH insensitivity
58
What do think about fine tremor in lithium therapy (fine, not coarse)?
-Symmetric -indistinguishable from physiologic or essential one -most apparent with intentional activities (holding a cup)
59
Onset of fine tremor in lithium therapy?
Early
60
Is Fine tremor in lithium therapy dose dependent?
Yep
61
what can help with fine tremor in lithium therapy?
Beta Blockers
62
Risk for developing fine tremor in lithium therapy?
old age
63
paradoxical side effect of lithium therapy?
weight gain despite loss of appetite
64
other side effects of lithium therapy?
- drowsiness -Metalic taste -Diarhoea -Muscle weakness
65
True or false: Lithium side effects are usually **not** dose dependent?
False They are usually dosedependent
66
Long Term Side effects of Lithium therapy
-Hypo-/Hyper thyroidism -Hypercalcaemia/Hyperparathyroidism -Irreversible Nephrogenic diabetic insipides -Reduced GFR
67
what is nephrogenic diabetic insipidus (DI) resulting in?
inability of kidneys to concentrate urine
68
how does lithium causes DI?
it causes dysregulation of principal cells in short term it causes loss of principal cell in long term
69
How to treat DI caused by lithium therapy? Lithium wise
Stop lithium if possible if not, keep level (0.4-0.8 mmol/L) Take once-daily dose
70
Medications that can help in Lithium induced DI?
Amiloride (k sparing) Thiazide diuretics Indomethacin Desmopressin
71
How indomethacin helps in lithium induced DI?
It blocks prostaglandin activity, which augments the action of ADH on principal (remember lithium-induced ADH sensitivity)
72
How does amilorides help in lithium induced DI?
Amiloride (K sparing) block Na channels and stop lithium going inside principle cells.

MRCPSYCH Paper B _ Mainly general Adult (mentor&more) (90 decks)

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