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ART_MRCPSYCH_B_MENTOR > 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
Q

BNF suggested therapeutic lithium level for maintenace and elderly?

A

Around 0.4 mmol/L

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26
Q

BNF suggested a therapeutic lithium level of 0.8-1 mmol/L.

A
  • Acute mania
    -Hx of Relapse
    -Sub-syndromal symptoms
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27
Q

Maudsley Suggests the minimum adequate plasma level of lithium for prophylaxis.

A

0.4 mmol/L

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28
Q

Maudsley Suggestes the Optimal adequate plasma level of lithium for prophylaxis?

A

0.6 - 1.2 mmol/L

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29
Q

Maudsley Suggestes the Protective plasma level of lithium against mania (prophylaxis?

A

> 0.75 mmol/L

30
Q

Maudsley Suggestes the TARGET adequate plasma level of lithium for prophylaxis?

A

0.6 - 0.75 mmol/L

31
Q

0.4 mmol/L

A

Maudsley Suggests the minimum adequate plasma level of lithium for prophylaxis.

32
Q

0.6 - 1.2 mmol/L

A

Maudsley Suggestes the Optimal adequate plasma level of lithium for prophylaxis?

33
Q

> 0.75 mmol/L

A

Maudsley Suggestes the Protective plasma level of lithium against mania (prophylaxis?

34
Q

0.6 - 0.75 mmol/L

A

Maudsley Suggestes the TARGET adequate plasma level of lithium for prophylaxis?

35
Q

what medication class can mess up lithium level?

A

NSAIDS
ACE inhibitors
Diuretics

36
Q

Risk F a c t o r s to cause lithium toxicity?

A
  • Drug interactions
    -Fever
    -Infections
    -Reduced circulating volume
    -Dehydration
    -Nephrogenic Diabetic Insepidus
37
Q

Drugs that increase Lithium Level?

A

NSAIDs (Aspirin)
COX-2 inhibitors (Celecoxib)
Thiazide (bendroflumethiazide)
ACE inhibitors (Captopril, ramipril)

38
Q

Drugs that have no effect on lithium but work in kiney?

A

Loop diuretics (Furosemide, bumetanide, and torsemide)

39
Q

Division of lithium toxicity

A

GIT
Neurology

40
Q

GIT features of lithium toxicity

A

Nausea
Vomitting
Diarrhoea
Abd. cramps

41
Q

Neurology related features of lithium toxicity?

A
  • Coarse Tremor
    -Seizure
  • Dystonia
  • Ataxia
    -Nystagmus
    -Hyperreflexia
    -confusion
42
Q

What scale is used to measure lithium toxicity?

A

AMDISEN

43
Q

Ratings on MDISEN = score 0

A

No signs or symptoms?

44
Q

Ratings on MDISEN = score 1

A

Mild symptoms

Nausea
Vomiting
Tremor
Hyperreflexia
Agitation
Weakness
Ataxia

45
Q

Ratings on MDISEN = score 2

A

Moderate

46
Q

Ratings on MDISEN = score 3

A

Severe

Cardiovascular
Coma
Seizure
Myoclonus

47
Q

what is metabolite of lithium called?

A

Lithium has no metabolite

It is not metabolized.

48
Q

Does Lithium bind to any protiens?

A

no
it roams free

49
Q

what congenital disease is thought to be associated with Lithium

A

Ebstein’s (had not held to be true recently)

50
Q

what is Ebstein’s?

A

Prolapse of the tricuspid valve into the right ventricle

51
Q

incidence of Ebstein’s?

A

1:20’000 of general population

52
Q

mnemonic of Lithium contraindications?

A

BAC LUC

53
Q

Contraindications for lithium?

A

BAC LUC

  • Brugada disease
    -Addison’s disease
    -Cardiovascular (arrythmia)

-Low sodium
-Untreated hypothyroidism
-Clinical signif. renal failure

54
Q

A patient on lithium comes in with nausea…what do you think caused it?

A

it might be related to the peak of the dose…divide the dose into two or three to reduce the peak

55
Q

prognosis for lithium induced nausea

A

may diminish over time

56
Q

what if lithium - induced - nausea was accompanied by vomitting?

A

it is probably due to toxicity not just a side effect

57
Q

what can cause lithium-induced polydipsia + polyurea?

A

ADH insensitivity

58
Q

What do think about fine tremor in lithium therapy (fine, not coarse)?

A

-Symmetric
-indistinguishable from physiologic or essential one
-most apparent with intentional activities (holding a cup)

59
Q

Onset of fine tremor in lithium therapy?

A

Early

60
Q

Is Fine tremor in lithium therapy dose dependent?

A

Yep

61
Q

what can help with fine tremor in lithium therapy?

A

Beta Blockers

62
Q

Risk for developing fine tremor in lithium therapy?

A

old age

63
Q

paradoxical side effect of lithium therapy?

A

weight gain despite loss of appetite

64
Q

other side effects of lithium therapy?

A
  • drowsiness
    -Metalic taste
    -Diarhoea
    -Muscle weakness
65
Q

True or false:
Lithium side effects are usually not dose dependent?

A

False

They are usually dosedependent

66
Q

Long Term Side effects of Lithium therapy

A

-Hypo-/Hyper thyroidism
-Hypercalcaemia/Hyperparathyroidism
-Irreversible Nephrogenic diabetic insipides
-Reduced GFR

67
Q

what is nephrogenic diabetic insipidus (DI) resulting in?

A

inability of kidneys to concentrate urine

68
Q

how does lithium causes DI?

A

it causes dysregulation of principal cells in short term
it causes loss of principal cell in long term

69
Q

How to treat DI caused by lithium therapy? Lithium wise

A

Stop lithium if possible
if not, keep level (0.4-0.8 mmol/L)
Take once-daily dose

70
Q

Medications that can help in Lithium induced DI?

A

Amiloride (k sparing)
Thiazide diuretics
Indomethacin
Desmopressin

71
Q

How indomethacin helps in lithium induced DI?

A

It blocks prostaglandin activity, which augments the action of ADH on principal

(remember lithium-induced ADH sensitivity)

72
Q

How does amilorides help in lithium induced DI?

A

Amiloride (K sparing) block Na channels and stop lithium going inside principle cells.

ART_MRCPSYCH_B_MENTOR (41 decks)

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