Lithium Flashcards
FDA indications for Lithium
Acute Mania
Maintenance
How many hours should you wait to recheck a trough level for lithium
At least 12 & before the next scheduled dosage.
How is Lithium metabolized
Kidneys
Baseline labs to obtain from Lithium:
TSH
BUN/Creatinine
CBC differential
EKG (> 40 years old or clinically indicated)
Serum Electrolytes
Serum Calcium ( Lithium can cause Hypercalcemia)
Interval of Lithium lab checks: Kidney labs
Baseline
2 to 3 months (first six months)
Annually (stable)
Interval of Lithium lab checks: Calcium
Baseline
2 to 6 weeks after initiation
q6 months to a year
Hypercalcemia: fatigue, weakness, abdominal pain, constipation, nephrolithiasis, bone pain.
Interval of Lithium lab checks: Thyroid
Baseline
1 to 2 times in the next 6 months
Annually (stable)
Interval of Lithium lab checks: CBC with differential
Baseline
as clinically indicated
Interval of Lithium lab checks: ECG
Check ALWAYS for anyone 40 years or older
Clinically indication: Cardiovascular
Interval of Lithium lab checks: Lithium level. (Not trough).
Every 5 days after a modification until stable
Then
3 to 6 months
Timing of serum samples: Lithium
Post 12 hours after last dose
A 12-hour trough level is preferred, but in some circumstances (eg, 3 times a day dosing, limited lab hours) it may be drawn 8 to 12 hours post dose.** A 10% to 26% increase of a 12-hour serum concentration can be expected with once-daily dosing compared to a 12-hour serum concentration checked of an equal dose that is given twice daily.**
When to check Lithium levels (days)
5 days
Initiation or modification of dosage
Bipolar disorder: acute mania therapeutic concentration
0.8 to 1.2 mEq/L
Bipolar disorder: maintenance therapeutic concentration
0.6 to 1 mEq/L
a higher rate of relapse is described in subjects who are maintained at <0.6 mEq/L .
Toxic serum therapeutic dosage of lithium
> 1.5
