Mood stabilisers

Question 1

what can be used as a mood stabiliser

Answer 1

lithium
sodium valproate
lamotrigine
carbamazepine

Question 2

how many hours after a dose should lithium levels be checked

Answer 2

12 hours post dose

Question 3

Therapeutic range lithium

Answer 3

0.4-1.0 mmol/L

Question 4

Adverse affects of lithium

Answer 4

Leukocytosis
Increased urination (insipidus)
Tremors (fine = SE, coarse = toxicity)
T wave flat/inverted
Hyperparathyroid –> hypercalcaemia
Hypothyroid (but enlarged thyroid)
Interactions (NSAIDs, ACEi, ARB, diuretics)
Upset stomach (diarrhoea, cramps, N+V)
Muscle weakness
Skin conditions (acne, psoriasis)

Question 5

After a change in dose, how often should lithium levels be checked

Answer 5

after a change in dose, lithium levels should be taken a week later and weekly until the levels are stable.

Question 6

When should thyroid and renal be checked when patients taking lithium

Answer 6

Every 6 months

Question 7

Lithium and white cells

Answer 7

Lithium can ppt benign leukocytosis

Question 8

Features of lithium toxicity

Answer 8

Levels >1.5
Increased reflexes
Tremor coarse
Hypotension
Increased tone
Upset stomach (N+V)
Myoclonus
Seizures

Oligogyric renal failure
Ataxia

Question 9

when lithium levels are stable, how often are they checked

Answer 9

Once stable, blood test 12 hours post-dose every 3 months

Question 10

what is the most common endocrine disorder that develops as a result of chronic lithium toxicity

Answer 10

hypothyroidism

Question 11

what can precipitate lithium toxicity

Answer 11

dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole. (these drugs increase reabsorption of lithium)

Question 12

management if lithium toxicity

Answer 12

Stop lithium
mild-moderate toxicity may respond to volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity
sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion

Question 13

caution lithium in which patients?

Answer 13

psoariasis
myasthenia gravis

Avoid in serious cardiac disease (heart failure, sick sinus syndrome), Addison’s disease, renal
impairment (if possible), pregnancy and breastfeeding

Question 14

lithium and diarrhoea/vomiting

Answer 14

Reduce dose or discontinue lithium in diarrhoea, vomiting and intercurrent infection
(especially if patient is sweating profusely)

Question 15

lithium and surgery

Answer 15

Discontinue lithium 24 hours before surgery and restart as soon as renal function and fluid
balance are back to normal

Question 16

baseline measurements therpaeutic monitoring lithium

Answer 16

renal: U&E, eGFR,

thyroid: free T4, TSH,

weight and height (plus FBC
and ECG if indicated).

Question 17

what should be checked every 3 months lithium

Answer 17

serum lithium level (normal therapeutic range 0.4-1.0mmol/l, set target
for each patient)

Question 18

what should be checked every 6 months lithium

Answer 18

thyroid and renal:

– fT4, TSH, U&E and eGFR

Question 19

what should be checked every 12 months lithium

Answer 19

check height and weight (BMI)

Question 20

above what range lithium toxicity can occur?

Answer 20

1.5