Term
| How do the pharmacokinetics of lithium change in different age groups? |
|
Definition
| Real clearance is shorter in children and longer in the elderly |
|
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Term
| What is the differential diagnosis (3 diagnoses) of depression in a patient taking maintenance lithium treatment? |
|
Definition
Lithium-induced hypothyroidism
Substance abuse
Lack of compliance |
|
|
Term
| What are the indications for lithium maintenance therapy? |
|
Definition
Second mood episode in bipolar I
First mood episode in adolescents or persons with a family history of bipolar I |
|
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Term
| What is the role of lithium in the treatment of MDD? |
|
Definition
| As effective as antidepressants. 50-60% of antidepressant non-responders will improve when lithium is added as an adjuvant treatment of depression. |
|
|
Term
| What percentage of patients taking lithium experiennce side effects? |
|
Definition
|
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Term
| What are the four "benign" neurological adverse effects of lithium, and the five "miscellaneous" ones? |
|
Definition
Benign, nontoxic: dysphoria, lack of spontaneity, slowed reaction time, memory difficulties
Miscellaneous: peripheral neuropathy, benign intracranial hypertension, myasthenia gravis-like syndrome, altered creativity, lowered seizure threshold |
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Term
| What are the 6 endocrine adverse effects associated with lithium? |
|
Definition
Goiter - 5%
Hypothyroidism - 7-10% (14% in women, 4.5% in men)
Exophthalmos
Hyperthyroidism (rare)
Hyperparathyroidism
Parathyroid adenoma |
|
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Term
| What are the three major renal effects of lithium? |
|
Definition
Reduced GFR
Polyuria with secondary polydipsia (renal DI)
Acure rubular necrosis |
|
|
Term
| What are the EKG changes in a patient taking lithium? |
|
Definition
| Similar to hypokalemia - T-wave flattening or inversion |
|
|
Term
| What is the toxic plasma concentration of lithium? |
|
Definition
1.5-2.0mEq/L - mild to moderate toxicity
2.0-2.5mEq/L - moderate to severe toxicity |
|
|
Term
| How can lithium be removed from the GI tract? |
|
Definition
| Polystyrene sulfonate (Kayexalate) or polyethylene glycol (GoLYTELY), but not activated charcoal. |
|
|
Term
| How should lithium be managed in a patient undergoing ECT? |
|
Definition
| Stop lithium 2 days before beginning ECT to reduce risk of delirium |
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|
Term
| What are the recommended serum concentration of lithium? |
|
Definition
Mania - 1.0-1.5mEq/L
Maintenance - 0.4-0.8mEq/L |
|
|
Term
| How should lithium levels be monitored? |
|
Definition
Every 2-6 months
Blood sample must be drawn 12 hours (±30 minutes) |
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