Lithium

Question 1

What is lithium used to treat?

Answer 1

Acute episodes of mania
Prevention of relapse in bipolar
Augmenting agent to treat recurrent depression

Question 2

What must be monitored prior to starting lithium and repeated every 6 months?

Answer 2

Weight - can cause weight gain
U+Es - can cause renal impairment
TFTs - can cause hypothyroidism
Ca2+ - can cause hyperparathyroidism
ECG - can cause arrhythmias, AV block

Question 3

How often should lithium levels be monitored?

Answer 3

-1 week after commencing / dose change
-Every 3 months once stable
-Must be measured 12h post-dose
-Target level is 0.4-1.0mmol/L
-Toxicity occurs >1.5mmol/L

Question 4

What are the key side effects / cautions for taking lithium?

Answer 4

Polyuria + polydipsia
Nausea
Fine tremor
Weight gain
Teratogenic
Severe water loss can lead to toxicity (wary of NSAIDs, diuretics)
Can cause neurotoxicity / serotonin syndrome if used with SSRIs

Question 5

What is valproate used for?

Answer 5

Treatment of mania and depression in bipolar disorder
Epilepsy
Must not be used in WCBAs (teratogen)

Question 6

What are some adverse effects of valproate?

Answer 6

Abdo pain
Menstrual irregularities
Dose-related tremor
Thrombocytopenia
Hair loss with curly regrowth

Question 7

What is carbamazepine used to treat?

Answer 7

An anticonvulsant
Lithium-resistant bipolar
Prophylactic agent for mania

Question 8

What risks are there for carbamazepine?

Answer 8

Agranulocytosis and hyponatraemia
Induces hepatic enzymes
Reduces clozapine conc