Lithium

Question 1

What is the therapeutic range of lithium for maintenance therapy and elderly patients?

Answer 1

0.4 to 1 mmol/L

The lower end of the range is specifically for maintenance therapy and elderly patients.

Question 2

What is the therapeutic range of lithium for acute episodes of mania?

Answer 2

0.8 to 1 mmol/L

This range is also applicable for patients who have previously relapsed or have sub-syndromal symptoms.

Question 3

What parameters should be monitored in patients taking lithium?

Answer 3

• Serum lithium concentration
• Renal function
• Cardiac function
• Thyroid function

Regular monitoring is crucial to ensure patient safety.

Question 4

What is the major route of elimination for lithium?

Answer 4

Renal

Lithium is freely filtered at the glomerulus with 80% reabsorbed.

Question 5

List some warning signs of lithium toxicity.

Answer 5

• Increasing gastrointestinal disturbances (e.g., vomiting, diarrhoea)
• Visual disturbances (e.g., blurred vision)
• CNS disturbances (e.g., drowsiness, unsteadiness, confusion)
• Fine tremor increasing to coarse tremor
• Muscle weakness
• Incontinence, polyuria

These signs indicate potential toxicity and require immediate attention.

Question 6

What serum concentration of lithium indicates severe overdosage?

Answer 6

Over 2 mmol/L

Severe overdosage can lead to seizures, coma, renal failure, arrhythmias, blood pressure changes, circulatory failure, and sudden death.

Question 7

What are signs and symptoms of hypothyroidism that may occur with lithium use?

Answer 7

Unexplained fatigue

Patients should be aware of these symptoms as they may indicate thyroid dysfunction.

Question 8

What actions should patients take if they experience warning signs while on lithium?

Answer 8

Report immediately to a doctor

Immediate medical attention is crucial for safety.

Question 9

What should patients be advised regarding lithium brands?

Answer 9

Stay on the same brand of lithium

Consistency in medication is important for effective treatment.

Question 10

What dietary considerations should be communicated to patients taking lithium?

Answer 10

Keep a constant and adequate salt and water intake

This is especially important during infections or hot weather.

Question 11

What should patients avoid while taking lithium?

Answer 11

Alcohol

Patients should also be informed about potential interactions with other medications.

Question 12

What is a potential risk when driving or operating machinery while on lithium?

Answer 12

Feeling sleepy

Patients should be counseled about this risk to ensure safety.

Question 13

True or False: Patients should stop taking lithium suddenly without consulting a doctor.

Answer 13

False

It’s important not to stop lithium suddenly unless directed by a healthcare provider.

Question 14

List some medications that increase the risk of lithium toxicity.

Answer 14

• ACE inhibitors
• Angiotensin-II receptor antagonists
• Loop diuretics
• Thiazides and related diuretics
• NSAIDs
• Potassium-sparing diuretics
• Aldosterone antagonists
• Metronidazole
• SSRIs
• Tricyclics

These interactions can significantly affect lithium levels.

Question 15

Which medication increases the risk of ventricular arrhythmias when used with lithium?

Answer 15

Amiodarone

Caution is advised when these medications are used together.

Question 16

What is a risk associated with the combination of lithium and methyldopa?

Answer 16

Neurotoxicity

Patients should be monitored for neurological symptoms.

Question 17

What type of side effects may be increased with the use of lithium and clozapine?

Answer 17

Extrapyramidal side effects

This includes effects like tremors and rigidity.