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Flashcards in Lithium therapy Deck (15):

What % of patients experience SE?

75% will experience some SE


What major dose-related side effects should you mention to the patient starting lithium therapy?

weight gain
cognitive problems (dulling, impaired memory, poor concentration, confusion)
Fine tremor
impaired coordination
gastrointestinal disturbances- Nausea, vomiting, dyspepsida, diarrhoea
Hair loss
Peripheral oedema


What regular monitoring is required in lithium therapy?

Serum lithium
Thyroid function tests


What is one option for treating the side effect of fine tremor?

Beta blocker


What is one option for treating the side effect of peripheral oedema?

loop or thiazide diuretic


What is one option for treating the side effect of acne?

Topical or systemic acne


What are some approaches for managing the GI side effects of lithium?

Take lithium with meals
use anti-emetic or PPI (omeprazole or lansoprazole)
Switch lithium preparation- lithium citrate or lithium carbonate


What are the long term effects of taking lithium?

may affect the kidneys and thyroid gland
>1% develop irreversible kidney failure after 10+ years
5-35% develop subclinical or clinical hypothyroidism, more in women than men, and usually between 6-18 months after commencing treatment


What specific advice should you give to women who are starting lithium therapy?

Adverse risks of pregnancy while on lithium
-8x risk of fetus developing Ebstein's anomaly- congential malformation of the tricuspid valve of the heart in 1st trimester
2/3rd trim: polyhydramnios, premature delivery, thyroid abnormalities, nephrogenic diabetes insipidus, floppy baby syndrome


What advice should be given to a woman with mild, stable bipolar disease who wishes to become pregnant?

Lithium dose may be tapered down and stopped pre-pregnancy.


What advice should be given to a woman with moderate risk of relapse in bipolar disorder, is on lithium who wishes to become pregnant?

Lithium should be tapered and discontinued during the first trimester


What advice should be given to a woman with severe bipolar disorder, on lithium, and wishes to become pregnant?

Lithium should be maintained
-proper informed consent
-appropriate counselling of the risks to the foetus
-prenatal diagnosis
-detailed ultrasound and echocardiography at 16-18 weeks gestation


What should you advice patients about lithium levels and toxicity?

Narrow therapeutic index
Upper limit- 1.2 mmol/L
-If >1.5mmol/L most have toxicity symptoms
-If >2.0mmol/L life-threatening toxic effects occur

Early s/s include: marked coarse tremor, poor appetite,nausea, vomiting, diarrhoea, associated lethargy and dehydration.

Later s/s: restlessness, muscle fasciculation, myoglonic jerks, increased muscle tone, ataxia, dyarthria, drowsiness,confusion, hypotension, cardiac arrhythmias, circulatory collapse, seizures, coma.

Advice: ensure adequate hydration and self intake. Lithium levels rise in dehydration.


What tests will be done before starting lithium? How often will they have blood tests?

Renal function- U/Es
Thyroid- TFT
Pregnancy test- if female

Check lithium after 5 days after initial dose
Then weekly until stable for 4 weeks
Then every 3 month
Then every 6 months


What drugs commonly interact with lithium?

calcium channel blockers