Podcast
Questions and Answers
What lifestyle adjustment should a patient on Lithium maintain to prevent toxicity?
What lifestyle adjustment should a patient on Lithium maintain to prevent toxicity?
- Increase protein intake
- Limit fluid intake to 1 quart/day
- Eat a normal diet with normal salt intake (correct)
- Avoid dehydration by drinking only caffeine-free beverages
Which of the following symptoms is associated with Grade 1 Lithium toxicity?
Which of the following symptoms is associated with Grade 1 Lithium toxicity?
- Rigidity
- Hyperreflexia (correct)
- Stupor
- Coma
What is the appropriate treatment for Grade 3 Lithium toxicity?
What is the appropriate treatment for Grade 3 Lithium toxicity?
- Hemodialysis (correct)
- Increased fluid intake
- Hydration
- Kayexalate
What is a contraindication for Lithium therapy?
What is a contraindication for Lithium therapy?
Which sign or symptom should a patient report to their healthcare provider that is a possible indication of Lithium toxicity?
Which sign or symptom should a patient report to their healthcare provider that is a possible indication of Lithium toxicity?
How should extended-release Lithium tablets be taken?
How should extended-release Lithium tablets be taken?
Why is it important for Lithium patients to keep frequent check-ups?
Why is it important for Lithium patients to keep frequent check-ups?
What might be a common side effect experienced by a patient taking Lithium?
What might be a common side effect experienced by a patient taking Lithium?
What is the usual maintenance dose range for lithium?
What is the usual maintenance dose range for lithium?
What is a common side effect of lithium that may occur in patients?
What is a common side effect of lithium that may occur in patients?
Which of the following is a method to monitor toxicity in patients taking lithium?
Which of the following is a method to monitor toxicity in patients taking lithium?
Which condition is NOT a sign of lithium toxicity?
Which condition is NOT a sign of lithium toxicity?
What is the unknown mechanism thought to be responsible for lithium's action in the CNS?
What is the unknown mechanism thought to be responsible for lithium's action in the CNS?
What is the initial dose range for lithium typically when starting therapy?
What is the initial dose range for lithium typically when starting therapy?
Which of the following indicates the use of lithium?
Which of the following indicates the use of lithium?
What are the potential drug-drug interactions that require close monitoring during lithium therapy?
What are the potential drug-drug interactions that require close monitoring during lithium therapy?
Flashcards
Lithium Toxicity Grade 1
Lithium Toxicity Grade 1
A level of lithium in the blood between 1.5-2.5 mEq/L, causing mild symptoms like nausea, vomiting, tremors, and muscle weakness.
Lithium Toxicity Grade 2
Lithium Toxicity Grade 2
A level of lithium in the blood between 2.5-3.5 mEq/L, causing moderate symptoms like muscle stiffness, decreased blood pressure, and confusion.
Lithium Toxicity Grade 3
Lithium Toxicity Grade 3
A level of lithium in the blood above 3.5 mEq/L, causing severe symptoms like comatose state and seizures.
Lithium Toxicity Grade 3: Coma and Seizures
Lithium Toxicity Grade 3: Coma and Seizures
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Hypersensitivity to Lithium
Hypersensitivity to Lithium
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Lithium Contraindication: Cardiac & Renal Disease
Lithium Contraindication: Cardiac & Renal Disease
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Lithium Contraindication: Pregnancy and Lactation
Lithium Contraindication: Pregnancy and Lactation
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Lithium Contraindication: Dehydration and Sodium Depletion
Lithium Contraindication: Dehydration and Sodium Depletion
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What is Lithium?
What is Lithium?
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What is the normal therapeutic range for lithium?
What is the normal therapeutic range for lithium?
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What are the signs of lithium toxicity?
What are the signs of lithium toxicity?
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How often should lithium levels be monitored?
How often should lithium levels be monitored?
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What are some of the medications that interact with lithium?
What are some of the medications that interact with lithium?
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What foods and drinks can interact with lithium?
What foods and drinks can interact with lithium?
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What are some common side effects of lithium?
What are some common side effects of lithium?
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What are the key things to remember when taking lithium?
What are the key things to remember when taking lithium?
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Study Notes
Lithium Carbonate: Pt Teaching
- Take the medication exactly as prescribed, with meals or food/milk. Do not chew or crush extended-release tablets.
- Maintain a normal diet and adequate fluid intake (at least 2.5 quarts/day).
- Arrange for frequent checkups, including blood tests.
- Discontinue the medication and notify the healthcare provider if toxicity symptoms occur (diarrhea, vomiting, ataxia, tremor, drowsiness, lack of coordination, muscular weakness).
Lithium Carbonate: Side Effects
- Possible Side Effects: drowsiness, dizziness (avoid driving or tasks requiring alertness), GI upset (eat small, frequent meals), mild thirst, increased urine output, fine hand tremor (report severe tremor to doctor).
- Report diarrhea and fever.
- Drug interactions: ACE inhibitors, thiazide diuretics, carbamazepine, NSAIDs, methyldopa, fluoxetine.
- Food interactions: caffeine (natural diuretic), maintain normal sodium intake.
Lithium Carbonate: Toxicity Grades & Management
- Grade 1 (1.5-2.5 mEq/L): Nausea, vomiting, tremors, hyperreflexia, ataxia, muscular weakness. Treatment: hydration every 4-6 hours, Kayexalate.
- Grade 2 (2.5-3.5 mEq/L): Hypertonia, hypotension, rigidity, stupor. Treatment: hydration, Kayexalate, dialysis.
- Grade 3 (>3.5 mEq/L): Coma and seizures. Treatment: hemodialysis.
Lithium Carbonate: Contraindications
- Hypersensitivity
- Cardiac and renal disease
- Dehydration and sodium depletion
- Brain damage
- Pregnancy and lactation
Lithium Carbonate: Black Box Warning
- Monitor clinical status closely, especially during the initial stages of therapy (twice per week).
- Monitor maintenance doses monthly.
- Monitor therapeutic serum levels (0.6-1.2 mEq/L).
- Toxicity is closely related to serum levels.
Lithium Dosage and Side Effects (Page 2)
- Initial dose: Typically 600-900 mg/day, divided into 2-3 doses.
- Maintenance dose: Generally 900-1200 mg/day, divided into 2-3 doses.
- Acute Mania/Severe Cases: May start higher (1800-2400 mg/day).
- Toxicity: Occurs when lithium levels exceed 1.5 mEq/L. Factors contributing to toxicity: fluid loss, dehydration, hyponatremia, decreased renal function, NSAIDs, thiazide diuretics, ACE inhibitors, antipsychotics, fluoxetine.
Lithium Carbonate: Classification and Action (Page 2)
- Mechanism of action unknown, thought to work in the CNS affecting neurotransmitter release. Decreases dopamine and norepinephrine, increases serotonin.
- Used to treat bipolar disorder, mania, hypomania, recurrent/severe depression.
- Used to treat symptoms of mania (high energy, happiness, lack of sleep, euphoric behavior).
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