Lithium counselling Flashcards

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1
Q

focussed hx bipolar

A

mania - ++ mood & energy; – need for sleep; irritable, impulsive, delusions, auditory hallucinations

depression - low mood, low energy, lack of enjoyment, poor sleep, appetite, concentration, risk

overview previous tx (compliance, feelings, side effects, ongoing)

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2
Q

once established px understanding move on to ATHLETICS

A

Action - block release of brain neurotransmitters –> stabilise mood & prevent prolapse in bipolar & severe depression (80% have good response)

Timing - OD at night

How to use - tablet or liquid

Length -
Effects -
Tests -
SEs -
CIs -

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3
Q

length

A

takes weeks to work
long-term; at least two years; many people on it forever

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4
Q

stopping & missed dose lithium

A

compliance is essential
do NOT suddenly stop (relapse) - reduce over 4 weeks

if 1 dose missed –> continue as normal & take if <10hrs
if 2 doses missed–> retitrate, do NOT take 2 doses

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5
Q

SEs

A

LITHIUM

lethargy
insipidious (polydypsia & polyuria)
tremor
hypothyroidism
insides (GI upset - N/V/D/C)
urea - increased
metalic taste

weight gain

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6
Q

serious SEs

A

damage to kidneys & thyroid

drink regularly & avoid NSAIDs/diuretics

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7
Q

explore toxicity

A

Li >1.5

causes: nephrotoxins; UTI, renal failure, dehydration

warning symptoms: worsening Sx, confusion, coarse tremor, hyperreflexia, choreoathetoid movements

safety-netting: get help in illness (modify dose) or toxicity call 999

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8
Q

monitoring (baseline & ongoing)

A

Li levels (0.5-1) at 12hrs post-dose –> 5 days later –> weekly until stable –> (weekly for) 4 weeks once stable –> 3-monthly once levels steady
U+Es + creatinine: baseline & 6-monthly
weight: baseline + 6 monthly
TFTs
Ca: baseline & annual

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9
Q

concurrent use with antidepressants

A

can be used sometimes
antidepressants in isolation increase risk of relapse

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10
Q

pregnancy

A

avoid lithium in 1st trimester
offer contraception

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