Mood stabilisters i.e Lithium Flashcards
What is lithium used for?
The treatment and prophylaxis of mania, bipolar disorder, recurrent depression, and aggressive or self-harming behaviour.
What are the contraindications of lithium?
Addison’s disease, cardiac insufficiency, dehydration, personal/family history of Brugada syndrome, low sodium diet, rhythm disorder, untreated hypothyroidism.
What is the mechanism of action of lithium?
Lithium is an alkali metal available for medical use as lithium carbonate or lithium citrate. The exact mechanism of action of lithium in the treatment of bipolar disorders is still not fully understood. However, lithium modifies the production and turnover of certain neurotransmitters, particularly serotonin, and it may also block dopamine receptors. It modifies concentrations of some electrolytes, particularly calcium and magnesium, and it may reduce thyroid activity.
What are the monitoring requirements of lithium?
Serum-lithium concentrations must be monitored regularly as lithium salts have a narrow therapeutic/toxic ratio. Take samples 12 hours after initial dose to achieve serum-lithium concentration of 0.4 – 1 mmol/litre. For acute episodes of mania, for patients who have previously relapsed and who have sub-syndromal symptoms, the target is 0.8 – 1 mmol/litre. The optimum range for each patient should be determined. Routine serum-lithium monitoring should be performed weekly after beginning treatment and after each dose change until concentrations are stable, then every 3 months. Additional measurements required if patient develops significant intercurrent disease or change in sodium or fluid intake. Renal function should be monitored at baseline and every 6 months after (or more frequent if other risk factors such as taking ACE inhibitors, NSAIDs or diuretics). Assess cardiac and thyroid function before starting treatment, then every 6 months after.
What is the treatment cessation protocol for lithium?
Dose should be reduced gradually over at least 4 weeks (ideally over 3 months) as stopping abruptly risks relapse of symptoms. If stopped abruptly, consider changing to an atypical antipsychotic or valproate.
What is the patient/carer advice for lithium?
Advise patients to report signs/symptoms of lithium toxicity, hypothyroidism, renal dysfunction (polyuria, polydipsia) and benign intracranial hypertension (headaches, visual disturbances). Also maintain adequate fluid intake, avoid dietary changes which reduce/increase sodium intake. May impair driving, performance of skilled tasks, operating machinery etc. Patients should also be given a lithium treatment pack when starting treatment.
