Lithium

Question 1

What is DSM - IV ?

Answer 1

Diagnostic and statistical manual of mental disorder 4th ed

Question 2

What is lithium used for?

Answer 2

Acute mania and bipolar. Also many other uses not approved by the FDA

Question 3

When should lithium levels be drawn?

Answer 3

Drug levels should be drawn immediately prior to next dose

Question 4

What is the normal drug levels with lithium?

Answer 4

.6 - 1.2 meq/L for long-term control.
1.0 - 1.5 meq/L for acute mania
Should not exceed 2 meq/L

Question 5

How often should lithium levels be done?

Answer 5

Twice a week during the acute phase.

Once every two months during maintenance

Question 6

How is lithium excreted?

Answer 6

By the kidneys, GFR is directly effected.

Lithium can affect the ability of the kidney to concentrate urine

Question 7

Since reabsorption of lithium and sodium is competitive, what can hyponatremia lead to?

Answer 7

An increase in lithium reabsorption

Question 8

What can NSAIDs, carbamazepine, and tetracycline, dehydration cause with lithium?

Answer 8

Lithium toxicity

Question 9

What effect does loop diuretics( furosemide) and caffeine have on lithium?

Answer 9

They facilitate lithium excretion

Question 10

What should you do if a patient is on lithium and absolutely needs NSAIDs or hydrochlorothiazide/Loop diuretics?

Answer 10

Lower lithium dose by 50% and retitrate
Sulindac is one of the few NSAIDs that has minimal effect on lithium
Use Tylenol and aspirin

Question 11

What is the Cooper – Simpson test?

Answer 11

600 mg challenge dose, 24 hours later a serum lithium level is drawn.
Results of the test give a clinician a safe target does not necessarily a well-tolerated. With the results there is a chart according to the bloodwork of what the dose should be.

Question 12

What are common side effects of with lithium?

Answer 12

Thirst, polyuria, fatigue nausea, diarrhea, tremor, acne, weight gain
EKG changes, benign leukocytosis.
Rare diabetes insipidus, EPS worsening, hypothyroidism

Question 13

What does toxicity of lithium look like?

Answer 13

Think of a drunk person

Question 14

Managing lithium overdose/toxic levels

Answer 14

Induction of vomiting gastric lavage if less than four hours
Discontinue lithium for 1 to 2 days and monitor electrolytes (na) and renal function
Replace sodium with normal saline hydration if urine output is adequate. Hemodialysis for renal insufficiency of failure.
EKG changes include bradycardia and T-wave changes

Question 15

Children may need higher doses of lithium due to?

Answer 15

A higher GFR leading to shorter lithium half-life in circulation

Question 16

How long does lithium take to work?

Answer 16

About one week

Question 17

What is Lithiums half-life in the elderly?

Answer 17

36 hours

Question 18

Benign tremor can be managed with?

Answer 18

Propranolol

Question 19

Off label uses for lithium

Answer 19

Antidepressant augmentation, aggression, antipsychotic augmentation

Question 20

Lithium is contraindicated in?

Answer 20

Severe cardiovascular disease, severe renal disease, first trimester of pregnancy, leukemia

Question 21

Steady state is achieved for lithium level in?

Answer 21

4-5 days following the initiation of lithium

Question 22

What are the effects of caffeine & sodium supplement on Lithium?

Answer 22

Lower lithium concentration

Question 23

What is the effect of ace inhibitors, NSAIDs on lithium?

Answer 23

They raise lithium levels

Question 24

Pre-drug work up?

Answer 24

CBC with diff, electrolytes, thyroid function, renal function and EKG especially if > 40 yrs and or cardiac disease

Question 25

What is leukocytosis?

Answer 25

Elevated number of white blood cells.