Lithium

Question 1

Indications for Lithium? (Mood stabiliser) (4)

Answer 1

BAD
Recurrent/severe depression (augmentation)
Mania (prophylactically)
Agressive behaviour

Question 2

What are the benefits of Li?

Answer 2

Decrease suicide risk

Decreased mood swings

Question 3

What is the narrow therapeutic range of Li?

Answer 3

plasma level 0.4-1.0

Question 4

When should Li levels be checked?

What else should be checked?

Answer 4

Before treatment starts, 12 hrs post dose & after 5 days & every 3 months once stable
ECG, physical weight, U&E’s, TFTs, FBC, LFTS, Calcium

Question 5

Typically used for how long?

Answer 5

3 yrs

Question 6

Early side effects? (6)

Answer 6

diabetic symptoms
GI disturbance: nausea, vomiting & diarrhoea
Metallic taste
dry mouth
fine tremor & muscle weakness 
drowsy
weight gain

Question 7

Late SE? (5)

Answer 7

Thyrotoxicity 
Nephrotoxicity 
Weight gain
Arrhythmia (QTc prolongation)
Oedema

Question 8

Which drugs to avoid? (3)

Answer 8

Increased excretion drugs:
Diuretics 
ACE-i
Alcohol 
NSAIDS

Carbamazepine
Antacids

Question 9

Symptoms of Li toxicity? (4)

Answer 9

Increased tremor
blurred vision 
D&V
delirium 
confusion
seizure
coma

Question 10

Mx of Li toxicity? (4)

Answer 10

Stop lithium
Give fluids
Start osmotic diuresis/dialysis
Check levels for 1 week

Question 11

Lifestyle advice?

Answer 11

Stay hydrated + not in pregnancy