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A - MSRA Drugs [4] > Lithium > Flashcards

Lithium Flashcards

1
Q

Give 2 examples of lithium formulations

A
  • Lithium citrate

- Lithium carbonate

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2
Q

Why is it important to keep the patient on the same lithium formulation throughout treatment?

A

Contain different concentrations of lithium

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3
Q

On what basis is lithium prescribed?

A

By brand

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4
Q

What is the mechanism of action of lithium?

A
  • Modifies the production and turnover of certain neurotransmitters, particularly serotonin, and may also block dopamine receptors.
  • Alters concentrations of certain electrolytes, and may reduce thyroid activity
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5
Q

What are the routes of delivery of lithium?

A

PO

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6
Q

What are the indications for lithium?

A
  • Acute episodes of mania and hypomania
  • Recurrent depression where treatment with other anti-depressants has failed
  • Bipolar affective disorder
  • Control of aggressive behaviour or intentional self harm
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7
Q

What are the contraindications to lithium?

A
  • Cardiac disease
  • Personal or family history of Bruguda syndrome
  • Untreated hypothyroidism
  • Breastfeeding
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8
Q

Why is lithium contraindicated in untreated hypothyroidism?

A

Because lithium therapy can cause or exacerbate hypothyroidism

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9
Q

Why is lithium therapy contraindicated in breastfeeding?

A

Present in breastmilk

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10
Q

When should lithium be used with caution?

A
  • Pregnancy

- Patients with low body sodium levels, e.g. dehydrated, taking low sodium diet

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11
Q

Why should lithium be used with caution in pregnancy?

A

Risk of fetal cardiac malformation (Epstein’s anomaly)

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12
Q

When should lithium be considered in pregnancy?

A

If benefit outweighs risk

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13
Q

What medications might lithium interact with to cause increased serum lithium concentration?

A
  • Diuretics
  • ACEi and ARBs
  • NSAIDs
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14
Q

What medications might lithium interact with to cause reduce serum lithium concentrations?

A

Sodium chloride supplements

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15
Q

What medications might lithium interact with to cause QT prolongation?

A
  • Amiodarone

- Venlafaxine

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16
Q

What medications might lithium interact with to cause an increased risk of tornadoes de pointes?

A
  • Amiophylline

- Clarithryomycin

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17
Q

What medications might lithium interact with to cause an increased risk of serotonin syndrome?

A
  • SSRIs

- MAOIs

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18
Q

Why is monitoring important with lithium?

A

Narrow therapeutic window and high toxicity risk

19
Q

How should lithium be monitored?

A
  • Monitor plasma lithium levels
  • Renal function
  • BP, weight, BMI
20
Q

What should plasma lithium levels be?

A

0.4-1mmol/L

21
Q

What should be done before starting lithium?

A
  • Measure patients weight

- Check FBC, U&Es, TFTs, GFR, and obtain an ECG

22
Q

When should lithium levels be checked?

A

1 week after starting, and every dose adjustment

23
Q

How long after dose of lithium should levels be checked?

A

12 hours after last dose

24
Q

How often should renal function be checked when the patient is on lithium?

A

Every 6 months

25
Q

Why should renal function be checked every 6 months with lithium?

A

It is excreted by the kidneys

26
Q

How often should BP, weight, and BMI be checked with lithium?

A

Annually

27
Q

What should you do if the patients weight increases significantly during lithium treatment?

A

Consider weight management strategies to avoid adverse effects on patients health

28
Q

What are the common side effects of lithium?

A
  • Fine tremor
  • Thirst
  • Polyuria and diabetes insipidus
  • Weight gain
  • Metallic taste in mouth
  • Hypothyroidism
  • Goitre
29
Q

What are the rare side effects of lithium?

A

Lithium toxicity

30
Q

What are the signs of lithium toxicity?

A
  • Anorexia
  • Nausea
  • Vomiting
  • Nystagmus
  • Coarse tremor
  • Dysarthria
  • Ataxia
  • Seizure
  • LoC
  • Death
31
Q

What patient counselling is required with lithium?

A
  • Why and how to take lithium
  • Stay hydrated and do not make dietary changes
  • Non-compliance and risk of relapse
  • Blood tests
  • Signs of lithium toxicity
  • Lithium treatment card
  • Same brand
  • Withdrawal
  • Contraception
32
Q

What should the patient be told about why they are starting lithium?

A

Mood stabiliser

33
Q

How long should lithium therapy be continued for?

A

Should not start unless intention to continue for 3 years

34
Q

Why should you not start lithium unless there is an intention to continue for at least 3 years?

A

Poor compliance may precipitate rebound mania or hypomania

35
Q

What should the patient be told about how to take lithium?

A

Should be taken at the same time each day, and should not take more than prescribed dose

36
Q

What should the patient be told about hydration and diet with lithium?

A

Important to maintain adequate fluid intake and avoid dietary changes that increase or decrease sodium intake

37
Q

What should the patient be told about non-compliance with lithium?

A

Important patient does not stop taking lithium unless advised by a doctor, as if they stop taking suddenly there is risk of relapse

38
Q

What should the patient be told about blood tests with lithium?

A

At start of treatment patient will have regular blood tests to ensure that level of lithium in blood is sufficient, as lithium has narrow therapeutic range and risk of toxicity if dose is incorrect

39
Q

What should the patient be told about signs of lithium toxicity?

A

Should be aware of and vigilant for signs of lithium toxicity. Important to seek medical help immediately if lithium toxicity is suspected

40
Q

What should the patient be told about a lithium treatment card?

A

Advise patient to carry a lithium treatment card and to inform any health professionals that they are treated by about their lithium therapy, including OTC medications

41
Q

What should the patient be told about the same brand of lithium?

A

Important patient is maintained on same formation of lithium during treatment once they are stable. Advise patient to check brand of lithium they are prescribed every time they receive a new prescription from their doctor, and when they collect lithium at the pharmacy, to detect any prescription errors

42
Q

What should the patient be told about withdrawal of lithium medication?

A

If lithium should be withdrawn, should be done gradually and under medical supervision

43
Q

What should the patient be told about contraception with lithium?

A

Lithium is a teratogenic drug, so should be avoided in pregnant women. Sexually active females of child-bearing age are advised to use contraception

A - MSRA Drugs [4] (79 decks)

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