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Bipolar Disorder > Lithium > Flashcards

Lithium Flashcards

1
Q

Initial labs (9)

A

Creatine

BUN

GFR

Serum electrolytes

CBC with WBC differential

Serum hCG

UA

Baseline EKG

Lithium level

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2
Q

How often to to check lithium

A

12 hour post dose

After 4 days on medications

Every 4-5 days during initial trial

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3
Q

How often to check labs long term

A

Every 1-2 months to every 6-12 months

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4
Q

Which labs to check long term (7)

A

Creatine

BUN

GFR

TSH

UA

CBC

12 hour trough

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5
Q

When should EKG be checked 6-12 months

A

Patients over 50

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6
Q

Acute lithium level

A

0.8 - 1.2

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7
Q

Maintenance lithium level

A

0.6 - 1.0

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8
Q

Pharmacokinetics of lithium

A

Absorbed in the GI. Then excreted out

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9
Q

What organ is important in lithium levels

A

Kidney function

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10
Q

When is lithium contraindicated

A

Acute renal failure

Severe dehydration

Sodium depletion

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11
Q

When can lithium be used safely

A

Healthy kidney

CKD

Kidney transplants

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12
Q

When should we monitor and reduce lithium levels in GFR lab

A

< 60 mL/min

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13
Q

How does dehydration affect lithium

A

Increase

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14
Q

How does increase sodium affect lithium

A

Decrease

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15
Q

How does decrease sodium affect lithium

A

Increase

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16
Q

When does lithium toxicity levels begin to manifest

A

At 1.5 or greater

17
Q

Symptoms of lithium toxicity

A

Mental: Lethargy , Fatigue, Confusion

Musculoskeletal: Clumsiness, Weakness, SEVERE TREMOR

GI: Cramping, Nausea, Vomiting

Vision: Blurred

18
Q

Signs of lithium toxicity

A

Vision: Nystagmus

Muscle: Ataxia, DTR

Mental: AMS

CV: Arrhythmia

19
Q

Medications that increase lithium

A

Blood pressure: ACE, ARB, Potassium sparing/Thiazide diuretics

Pain management: NSAIDs

ABX: Flagyl

20
Q

Medication that can Decrease lithium levels

A

Theophylline

21
Q

Side effects of lithium

A

Neuro: hand tremor

General : weight gain

Renal : polydipsia or polyuria

Elevate TSH

22
Q

What type of therapeutic index does lithium have

A

A narrow one

[That means therapeutic levels are close to toxicity]

23
Q

Polyuria

A

Large volume of pee

24
Q

Polydipsia

A

Very thirsty

25
Q

How does lithium affect Suicidal ideation

A

Highest reduction for it

Bipolar Disorder (6 decks)

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