Lithium (High risk) Flashcards
who is lithium contra-indicated in? (6)
1) Addison’s disease,
2) Untreated hypothyroidism
3) Cardiac insufficiency
4) Dehydration
5) Brugada syndrome (serious heart rhythm disorder)
6) low sodium diets
Long-term use of lithium has been associated with what disorders/ side effects?
Associated with thyroid disorders and mild cognitive and memory impairment
↳ Monitor thyroid function every 6 months
The need for continued therapy with lithium should be assessed regularly. patients should be maintained on lithium for how many years only if treatment is beneficial?
Patients should be maintained on lithium after 3–5 years only if benefit persists
signs and symptoms of lithium intoxication require withdrawal of treatment. What are the signs and symptoms of lithium intoxication?
1) Early features may include apathy and restlessness
2) Increasing GI symptoms (vomiting diarrhoea)
3) CNS disturbances (confusion and drowsiness, lack of coordination, restlessness, ataxia)
4) Muscle twitching, and tremor
5) Dysarthria (Difficulty speaking)
6) Visual disturbances
7) Polyuria, Incontinence
what are the signs and symptoms of a severe lithium overdose? (5)
1) Convulsions
2) Coma
3) Renal failure
4) Electrolyte imbalance (Hypernatraemia)
5) Dehydration and hypotension.
Therapeutic drug monitoring of serum lithium concentrations is important due to its narrow therapeutic index.
1) How long after a dose of lithium should samples be taken
2) what is the target serum-lithium concentration that should be achieved?
1) Samples should be taken 12 hours after the dose
2) target is to achieve serum-lithium concentration of 0.4–1 mmol/litre (lower end of the range for maintenance therapy and elderly patients)
What is the recommended serum-lithium concentration for acute episodes of mania or for those who have previously relapsed?
0.8–1 mmol/litre
How often should routine serum-lithium monitoring be performed:
1) Initially
2) when the patient is stable
1) weekly after initiation and after each dose change until concentrations are stable
2) when patient stable measure every 3 months
Additional serum-lithium measurements should be made if a patient develops what? (2)
1) Significant intercurrent disease
2) Significant change in a sodium or fluid intake
What parameters should be measured in patients before initiating lithium treatment?
1) Assess Renal, cardiac, thyroid function, body-weight or BMI, serum electrolytes, and a FBC before treatment initiation.
2) An ECG is recommended in patients with cardiovascular disease or risk factors for it.
what patient parameters should be measured every 6 months with lithium therapy?
1) Monitor body-weight or BMI
2) Serum electrolytes
3) Renal function: eGFR
4) thyroid function
5)(Manufacturer also advises to monitor cardiac function)
↳ (measure more often if impaired renal or thyroid function, or raised calcium levels)
Explain why should lithium not be discontinued abruptly and outline how treatment withdrawal should be managed
1) abrupt withdrawal : Increases the risk of relapse
2) Dose should be reduced gradually over a period of at least 4 weeks (preferably up to 3 months)
3) Patients should be warned of the risk of relapse if lithium is discontinued abruptly
If lithium is stopped or is to be discontinued abruptly what other drugs could be considered?
Atypical antipsychotic (quetiapine, olanzapine, risperidone, clozapine) or valproate
what patient and carer advice should be given to those taking lithium?
1) Report symptoms of lithium toxicity, hypothyroidism, renal dysfunction (including polyuria and polydipsia (thirst)), and benign intracranial hypertension (persistent headache and visual disturbance).
2) Maintain adequate fluid intake and avoid dietary changes which reduce or increase sodium intake.
3) May impair performance of skilled tasks
A lithium treatment pack should be given to patients on initiation of treatment with lithium. List what the pack contains
1) Patient information booklet
2) Lithium alert card
3) Record book for tracking serum-lithium concentration
