Lithium

Question 1

Indications

Answer 1

Mania and hypomania
Prohylaxis of bipolar affective disorder
Depression
Control of aggressive behaviour

Question 2

Whst is the starting dose in adults

Wjst is the staring dose in the elderly

Answer 2

400mg

Elderly 200-250mg

Question 3

Whst is the toxic level of lithium

Answer 3

Over 1 but also when they dhow signs if toxicity

Question 4

What are the signs of toxicity

Answer 4

Nausea, coarse tremor, disrrhoea, poor concentration ecg abnormalities seizures renal failure vomiting slurred speech

Question 5

Monitoring requirements and frequency

Answer 5

Plasma lithium 1 week after starting then 4-7 days after sny dose change ir stable. Then every 3 months fir first year then every 6 months theresfter
U and e, FBC, TFT, weight BMI, calcium and eGFR every 6 months.
Physical assessment for signs lf toxicity
More frequent tests if there sre problems with this

Question 6

Drug interactions

Answer 6

CCB
SSRI- sertraline, moclobemide, fluoxetine
Antihypertensives propanolol, spironolactone, prils (not ramipril) sartans
Antipsychotics typical and clozapine
Antibiotic- metronidazole, doxycycline tetracycline levofloxacin
Caffeine
Alcohol
Diuretic- bendroflumethazide, furosemide
Nsaid
Sodium salt e.g antacids, gaviscon