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Pharmacokinetics > Lithium Pharmacokinetics > Flashcards

Lithium Pharmacokinetics Flashcards

1
Q

What is Lithium clearance?

A

0.25 x CrCl

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2
Q

What is the conversion factor of Li between mEq and mg?

A

0.12mEq/300mg

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2
Q

How many days until the steady state of Li is reached?

A

3-5 days

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3
Q

What is the bioavaliability (F) of Li?

A

1

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4
Q

How is Li distributed?

A

not protein bound, evenly distributed in total body water

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5
Q

When is the Cmax of Li?

A
  • IR= 1-3hrs
  • SR= 4-6hrs may be up to 12hrs in OD
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6
Q

How is Li excreted?

A

unchanged in urine, approx 75-80% reabsorbed

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7
Q

What is the half life of Li?

A

~20hrs, treatment duration increases t1/2 by 40-50%

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8
Q

Where in the glomerulus is Li reabsorbed?

A

70-80% in the proximal tubule

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9
Q

Where can Li bind in the glomerulus?

A

sodium-dependent co-transporter sodium channel (ENaC) and Na/H exchanger

Li binds over Na causing excess Na loss

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10
Q

What may occur with long-term use of Li?

A

NDI

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11
Q

How does long-term Li use result in NDI?

A

inhibits cAMP formulation and promotes lack of ADH = lose ability to reabsorb water

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12
Q

What is the treatment of NDI?

A

amiloride

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13
Q

What are the factors that increase Li clearance?

A
  • Na loading
  • pregnancy
  • acute mania
  • daytime dosing
  • drug interactions
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14
Q

What are the factors that decrease Li clearance?

A
  • advance age
  • drug interactions
  • renal impairment
  • dehydration
  • Li use > 1 year
  • nighttime dosing
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15
Q

At what renal clearance should Li be avoided?

A

CrCl < 30 mL/min

16
Q

What is the initial dosing of Li for acute mania?

A

300-600BID-TID

17
Q

What is the typical dosing range of Li?

A

900-2400 mg/day

18
Q

What is the positive of simplifying the Li dosing regimen to once a day dosing?

A

less polyuria and reduced renal concentration capacity

19
Q

What factors can affect measured drug levels of Lithum?

A
  • dosing schedule variations/adherence
  • preparation
  • crash diets/changes in salt intake
  • renal function
  • hydration status
  • interacting meds
20
Q

What is the result of volume depletion with Li use?

A

volume depletion due to illness/conditions= decreased renal diffusion= increased proximal tubule Na reabsorption= increased Li reabsorption= risk of TOXICITY

21
Q

What diuretic may be used safely with Li?

A

loops

22
Q

What are the drug interactions of Li?

A
  • ACE/ARB= Na depletion, Li retention= increased Li levels= risk of toxicity
  • NSAIDs= decreased renal blood flow, increased tubular reabsorption= decreased Li clearance= increased Li levels= risk of toxicity
23
Q

Which NSAIDs are associated with the highest risk of Li toxicity?

A

indomethacin, ibuprofen, naproxen

24
Q

When would hempdialysis be used for a patient who OD?

A

any level over 6 or a lever over 4 in chronic use

Pharmacokinetics (6 decks)

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