Lithium

Question 1

Lithium
Brand Name

Answer 1

Lithobid
Eskalith

Question 2

Lithium
Formulations

Answer 2

IR Capsule:
150mg, 300mg, 600mg
Solution:
8mEq/mL
IR/ER Tablet:
300mg, 450mg

Question 3

Lithium
On-Label Indications

Answer 3

Bipolar Disorder
-Acute mania, mixed features, maintenance

Question 4

Lithium
Off-Label Indications

Answer 4

Hypomania
Bipolar Depression
MDD

Question 5

Lithium
MOA

Answer 5

Unknown,
Naturally occurring salt, modifies sodium ion transport in nerve and muscle cells

Question 6

Lithium
CYP450 Pathway

Answer 6

Not Metabolized

Question 7

Lithium
Dose Range (Adult)

Answer 7

600-1800mg/day
in 2-3 divided doses

Question 8

Lithium
Titration

Answer 8

Increase by 300-600mg Q1-5d in divided doses

Question 9

Lithium
Dosing (Kidney Impairement)

Answer 9

CrCl 30 to <60 mL/min: start 150-300mg/day in 1-2 divided doses, slow titration
CrCl <30mL/min: Avoid use

Question 10

Lithium
Dosing (Liver Impairement)

Answer 10

No dosage adjustments

Question 11

Lithium
Dosing (Elderly)

Answer 11

Start at lower doses

Question 12

Lithium
OB Considerations

Answer 12

Pregnancy: avoid if possible, maternal benefit must outweigh newborn risk
Breastfeeding: avoid if possible

Question 13

Lithium
Side Effects

Answer 13

Cardiac effects - bradycardia
CNS effects - sedation
Derm effects - acne

Question 14

Lithium
Contraindications

Answer 14

Severe cardiac or renal disease
Severe dehydration
Brain damage

Question 15

Lithium
Major Interactions

Answer 15

ACE Inhibitors (lisinopril)
NSAIDs (ibuprofen, Celebrex)
Diuretics
COX-2 Inhibitors

Question 16

Lithium
Common Interactions

Answer 16

Methyldopa
Antacids (sodium bicarbonate)
Fluoxetine

Question 17

Lithium
Required Monitoring

Answer 17

Baseline labs within last year: renal/thyroid
Monitor within 7d starting or dose change, then Q6months:
Lithium levels
CMP (renal/liver)
TSH
Lipid panel

Question 18

Lithium
Therapeutic Ranges

Answer 18

0.4-1.2mmol/L
Acute mania tx:
0.8-1.2 mEq/L
Optimal range:
0.6-0.75mmol/L

Question 19

Lithium
Trough Lab Draw Timing

Answer 19

12 hours after last dose, before next dose

Question 20

Lithium
MILD Toxicity s/s

Answer 20

N/V
Lethargy
Tremor
Fatigue

Question 21

Lithium
MODERATE Toxicity s/s

Answer 21

Confusion
Agitation
Delirium
Tachycardia
Hypotension

Question 22

Lithium
SEVERE Toxicity s/s

Answer 22

Coma
Seizure
Hyperthermia
Hypotension

Question 23

Lithium
Pearls

Answer 23

“Gold standard” mood stabilizer
Reduces suicidality
Neuroprotective effects (lower risk dementia)