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?
cognitive problems (dulling, impaired memory, poor concentration, confusion)
gastrointestinal disturbances- Nausea, vomiting, dyspepsida, diarrhoea
What regular monitoring is required in lithium therapy?
Thyroid function tests
What is one option for treating the side effect of fine tremor?
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
-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
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