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Lithium, Teaching Resource - belongs to Dr Emma Ross, Advanced Clinical…
Lithium
Side-Effects
Fine tremor
Propanolol
Nephrogenic diabetes insipidus
Polyuria
Polydipsia
Mild GI upset
Aggravate psoriasis
Metallic taste
Ankle oedema
Weight gain
Advice
Overdose
Seek help
Intentional - consider dispensing/other meds
Effective
Reduces suicide rate
Best mood stabiliser
Different brands
Different doses
Prescribe by brand
Toxicity
Drug interactions
(Thiazide) diuretics
NSAIDs
ACE-inhibitors
Dehydration
Sick days
Discontinuation
Risk of relapse high
Pregnancy
Pregnancy
Risk of relapse high post-partum
Levels need checked more regularly
Potential dose increase in third trimester
Risk of cardiac abnormality
2/100 Lithium pregnancies
Most significant - Ebstein's anomaly
1/100 "normal" pregnancies
Consider on individual basis
Indications
BPAD
Maintenance
Gold standard
Acute mania
Depression
Monotherapy
Augmentation
Reduces suicide rate
Aggressive/self-harm behaviour
Adverse Effects
Toxicity
GI signs
Nausea
Diarrhoea
Anorexia
CNS signs
Coarse tremor
Drowsiness
Ataxia
Confusion
Muscle weakness/twitching
Seizures
Can be fatal
Treatment
Supportive (fluids etc)
Dialysis
Reduced renal function
Usually irreversible
Hypothyroidism
Usually reversible
Monitoring
Levels
Therapeutic range - 0.4-0.8
Toxic 1+
Take 12hrs post-dose
Pre-treatment
TFTs
U&Es
ECG if cardiac RFs
During treatment
Check level and above at least 6mthly
Type of drug
Mood stabiliser
Teaching Resource - belongs to Dr Emma Ross, Advanced Clinical Fellow