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
Depressive Disorder: maintenance therapeutic concentration
0.6 to 0.9 mEq/L
Typical initial dose of Lithium for Bipolar disorder
600 to 900 mg/day in 2 to 3 divided doses based on chosen formulation
initially administer IR daily dose in 2 to 3 divided doses and ER daily dose in 2 divided doses
How many mgs should you titrate when increasing the dose of lithium?
300 to 600 mg
What is the therapeutic dosage of lithium for bipolar disorder.
900mg/daily
Typical side effects of Lithium
Weight gain
Tremor
Cognitive issues (memory lapses)
Thirst
Acne
Worsening Psoriasis
Nausea
Diarrhea
Max dose of Lithium
2400mg/daily
How does Lithium impact thyroid
Hypothyoidism
Fatigue, weight gain, constipation, dry skin, puffy face, dry hair, muscle weakness, hair loss.
How does Lithium impact calcium
Hypercalcemia
fatigue, weakness, abdominal pain, constipation, nephrolithiasis, bone pain
Contraindications of Lithium
Severe Kidney
Dehydration
Low Thyroid
Allergic reaction
