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Pharmacology > Lithium > Flashcards

Lithium Flashcards

1
Q

Organ lithium is excreted by

A

Kidneys

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2
Q

Congenital anomaly associated with maternal lithium use during pregnancy

A

Ebstein’s anomaly

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3
Q

Risk of Ebstein’s anomaly in the general population

A

1 in 20000

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4
Q

Risk of Ebstein’s anomaly when exposed to lithium in utero

A

1 in 1000

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5
Q

Structural abnormality in Ebstein’s anomaly

A

Prolapse of the tricuspid valve into the right ventricle

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6
Q

ECG seen in therapeutic lithium levels

A

Flat or inverted T waves

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7
Q

Contraindications to lithium use

A 
Addison's disease
Brugada syndrome
Cardiac rhythm disorders including sick sinus syndrome
Significant renal impairment
Untreated hypothyroidism
Hyponatraemia
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8
Q

Common side effects of lithium treatment at therapeutic levels

A 
Nausea
Polyuria/polydipsia
Fine tremor
Blurred vision
Rash
Dizziness
Decreased appetite
Metallic taste
Causing and worsening psoriasis
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9
Q

Cause of polyuria and polydipsia in lithium use

A

ADH insensitivity

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10
Q

Long-term side effects of lithium use

A

Hypothyroidism or hyperthyroidism
Hypercalcaemia, hyperparathyroidism
Irreversible nephrogenic diabetes insipidus
Reduced eGFR

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11
Q

Features of lithium induced fine tremor

A 
Symmetrical
Largely in hands
Similar to physiological tremor
Typically occurs early in treatment
More common in older patients
Most apparent with intentional posture
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12
Q

Lithium levels to aim for in general circumstances

A

0.4-1.0mmol/L

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13
Q

Lithium levels to aim for if diabetes insipidus is a concern

A

0.4-0.8mmol/L

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14
Q

Cells affected in nephrogenic diabetes insipidus

A

Principle cells of the collecting duct

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15
Q

First line treatment for lithium induced nephrogenic diabetes insipidus

A

Amiloride

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16
Q

Treatments for lithium induced nephrogenic diabetes insipidus

A

Amiloride
Thiazide diuretics
Indomethacin
Desmopressin

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17
Q

Mechanism of action of amiloride in treating lithium associated nephrogenic diabetes insipidus

A

Blocks Na channels
Lithium cannot use Na channels to gain access to the principle cells of the collecting duct and cannot prevent water reabsorption there

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18
Q

Time lithium levels should be taken

A

12 hours post dose

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19
Q

Lithium levels to aim for in an acute manic episode

A

0.8-1.0

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20
Q

Drugs which increase lithium levels

A

NSAIDs
Thiazide diuretics
ACE inhibitors

21
Q

Impact of loop diuretics (e.g. furosemide) on lithium levels

A

Generally no change, can increase

22
Q

Risk factors for lithium toxicity

A 
Associated drugs
Decreased circulating volume e.g. sauna usage
Infections
Fever
Decreased oral intake
Renal insufficiency
Nephrogenic diabetes insipidus
Hyponatraemia
23
Q

Features of lithium toxicity

A 
Nausea, vomiting, diarrhoea, abdo pain
Coarse tremor
Confusion
Seizures
Dystonia
Hyperreflexia
Nystagmus
Ataxia
24
Q

Scale used to assess the severity of lithium toxicity

A

AMDISEN rating scale

25
Q

Features seen at stage 0 lithium toxicity on the AMDISEN scale

A

No clinical signs or symptoms

26
Q

Features seen at stage 1 lithium toxicity on the AMDISEN scale

A 
Nausea, vomiting
Tremor
Hyperreflexia
Agitation
Weakness
Ataxia
27
Q

Features seen at stage 2 lithium toxicity on the AMDISEN scale

A

Stupor
Rigidity
Hypertonia
Hypotension

28
Q

Features seen at stage 3 lithium toxicity on the AMDISEN scale

A

Myoclonus
Cardiovascular collapse
Seizure
Coma

29
Q

Baseline tests that must be performed before prescribing lithium

A

Renal function
ECG
TFTs
FBC

30
Q

When lithium levels should be checked

A

Weekly until levels are stable

3-6 monthly once stable

31
Q

When thyroid and renal function should be checked while on lithium

A

Every 6 months

32
Q

Timing of polyuria in patients taking lithium

A

Often associated with time of peak levels

33
Q

Cause of chronic renal damage in long term lithium use

A

Interstitial fibrosis

34
Q

Lithium level above which haemodialysis may be required

A

4mmol/L

35
Q

Most common thyroid effect of lithium use

A

Benign hypothyroid state

36
Q

Binding of lithium to serum proteins

A

Does not bind

37
Q

Form of lithium available as a liquid

A

Lithium citrate

38
Q

Form of lithium available as tablets

A

Lithium carbonate

39
Q

Indications for lithium

A

Treatment and prophylaxis of mania
Treatment and prophylaxis of bipolar disorder
Treatment and prophylaxis of recurrent depression
Treatment and prophylaxis of aggressive or self harming behaviour

40
Q

Level of binding lithium shows in the blood

A

Exists unbound

41
Q

Investigation to confirm lithium toxicity if level is normal

A

EEG

42
Q

Use for lithium prior to its being used for psychiatric illness

A

Gout

43
Q

Predictor of a poor response to lithium in patients with bipolar disorder

A

Rapid cycling bipolar disorder

44
Q

Demographic at highest risk of lithium induced hypothyroidism

A

Young women

45
Q

Dosing schedule which can improve lithium induced tremor

A

Small, more frequent doses

46
Q

Safety of lithium in the different trimesters of pregnancy

A

Should be avoided during the first trimester

47
Q

Safety of lithium while breastfeeding

A

Should be avoided

48
Q

Dosing measure which can improve lithium induced tremor

A

Smaller, more frequent doses

49
Q

Issue with fluid restriction as a treatment for lithium induced hyponatraemia

A

Can lead to severe hypernatraemia

Pharmacology (34 decks)

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