Lithium Flashcards
What is DSM - IV ?
Diagnostic and statistical manual of mental disorder 4th ed
What is lithium used for?
Acute mania and bipolar. Also many other uses not approved by the FDA
When should lithium levels be drawn?
Drug levels should be drawn immediately prior to next dose
What is the normal drug levels with lithium?
.6 - 1.2 meq/L for long-term control.
1.0 - 1.5 meq/L for acute mania
Should not exceed 2 meq/L
How often should lithium levels be done?
Twice a week during the acute phase.
Once every two months during maintenance
How is lithium excreted?
By the kidneys, GFR is directly effected.
Lithium can affect the ability of the kidney to concentrate urine
Since reabsorption of lithium and sodium is competitive, what can hyponatremia lead to?
An increase in lithium reabsorption
What can NSAIDs, carbamazepine, and tetracycline, dehydration cause with lithium?
Lithium toxicity
What effect does loop diuretics( furosemide) and caffeine have on lithium?
They facilitate lithium excretion
What should you do if a patient is on lithium and absolutely needs NSAIDs or hydrochlorothiazide/Loop diuretics?
Lower lithium dose by 50% and retitrate
Sulindac is one of the few NSAIDs that has minimal effect on lithium
Use Tylenol and aspirin
What is the Cooper – Simpson test?
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.
What are common side effects of with lithium?
Thirst, polyuria, fatigue nausea, diarrhea, tremor, acne, weight gain
EKG changes, benign leukocytosis.
Rare diabetes insipidus, EPS worsening, hypothyroidism
What does toxicity of lithium look like?
Think of a drunk person
Managing lithium overdose/toxic levels
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
Children may need higher doses of lithium due to?
A higher GFR leading to shorter lithium half-life in circulation
How long does lithium take to work?
About one week
What is Lithiums half-life in the elderly?
36 hours
Benign tremor can be managed with?
Propranolol
Off label uses for lithium
Antidepressant augmentation, aggression, antipsychotic augmentation
Lithium is contraindicated in?
Severe cardiovascular disease, severe renal disease, first trimester of pregnancy, leukemia
Steady state is achieved for lithium level in?
4-5 days following the initiation of lithium
What are the effects of caffeine & sodium supplement on Lithium?
Lower lithium concentration
What is the effect of ace inhibitors, NSAIDs on lithium?
They raise lithium levels
Pre-drug work up?
CBC with diff, electrolytes, thyroid function, renal function and EKG especially if > 40 yrs and or cardiac disease
