Lithium Flashcards
what is lithium used for?
acute and prophylactic management of bipolar
whats the therapeutic target range?
0.4 - 1.0 mmol/l
whats the therapeutic target range in acute manic episodes?
0.8 - 1 mmol/l
how long after a dose should you measure lithium levels?
12 hours post dose
how frequently to lithium levesl need to be monitoired?
weekly until stable
then 3 monthly for 1 yr
then 6 monthly after that
what are the signs of lithium toxicity? REVNG
Renal impairment - polyuria/incontinece
Extrapyridamal SE- tremours
Visual disturbances - blurred
Nervous system - confusion and restless
GI disorders - D&V
SICK AND TREMOUR
what are the other SE of lithium besides toxicity?
thyroid disorders
nephrotoxicity
rhabdomyolysis
QT prolongation
beningn intercranial hypertnesion
can lithium be used in pregnancy?
teratogenic in 1st trimester
what are the main interactions to look out for?
- hyponatraemia increases toxicity (diuretics, salt imbalance)
- serotonin syndrome with SSRIs
- EPSE with antipsycotics
- QT prolongation
- nephrotoxic drugs (NSAIDs, ACEi)
- Hypokalaemia
- drugs reducing seizure thresehold (QT EMAIL)
what tests make up lithium monitoring?
BMI
U&Es
Renal function
thyroid function tests
when might you increase lithium monitoring to 3 monthly?
if over 65yrs
poor symptom control
taking interacting medication
