LITHIUM JUNE 24

Question 1

Indications

Answer 1

• Mania,
• Bi-polar disorder,
• Self-harm and aggressive behavior,
• Recurrent depression

Question 2

Contraindications

Answer 2

Dehydration,
Low Na+ diet
increasing Li concentration,
Untreated hypothyroidism,
Renal impairmrnt
Addison’s,
Li causing Arrhythmia (avoid in cardiac disease)

Question 3

BF & Preg

Answer 3

• Avoid in 1st trimester,
• increased dose in late trimester,
• avoid breastfeeding,
• can return to normal dose after birth.

Question 4

Side effects

Answer 4

• Electrolyte imbalance,
• Hypothyroidism,
• Arrhythmia,
• Lower seizure threshold,
• Tremor, Polydipsia, GI issues, Leucocytosis,
• Memory loss,
• Skin reactions,
• Vision disorder
• , Intracranial
• HTN,
• QT prolongation, Renal dysfunction

Question 5

Interactions

Answer 5

EPS effects with antipsychotics,
Arrhythmia with QT drugs,
Lithium concentration increases with PPI, NSAIDs, ACE inhibitors, Diuretics, Trimethoprim, Metronidazole, Amiodarone. Lithium

concentration decreases with Theophylline, Carbonic inhibitors. Neurotoxicity with Antipsychotics, SSRI, Triptans, Diltiazem, Verapamil, Carbamazepine.

Question 6

Cautions

Answer 6

• What cautions should be observed with lithium and diuretics? -
• Hyponatremia causing lithium toxicity, Arrhythmia with QT prolongation drugs,
• Caution in epilepsy, elderly, and those with current cardiac disease.

Question 7

Monitor Before Treatment

Answer 7

• Assess renal, cardiac, and thyroid function. ECG in CVD patients. BMI, electrolytes, FBC.

Question 8

Monitor During Treatment

Answer 8

• Lithium concentration every 3 months, then every 6 months. Renal function every 6 months. Cardiac function every 6 months. Thyroid function every 6 months.

Question 9

Lithium Overdose

Answer 9

• What are the signs of lithium overdose? - Seizure, cardiac arrest, Sinoatrial block, Bradycardia, 1st degree heart block, BP changes, Circulatory failure, Renal failure, Coma, and sudden death reported.

Question 10

Warning Signs of Lithium Toxicity

Answer 10

• Serum levels 0.8 – 4 mmol/L, increased urination, incontinence, thirst, tremor, teratogenic effects, hypothyroidism, hyponatremia, interactions with NSAIDs, ACE inhibitors, diuretics, antacids, upset stomach, muscle weakness, skin effects.