29 Questions
What medication is the patient taking for her dyslipidemia?
None of the above
What is the patient's primary reason for using marijuana daily?
To help her sleep
What is the patient's diagnosis that is being treated with a bisphosphonate?
Osteoporosis
What is the patient's primary care provider's role in this scenario?
To manage the patient's chronic nausea and vomiting
What is the significance of serotonin in the patient's diagnosis?
It is a neurotransmitter that regulates both anxiety and mood
What is the main benefit of down regulating excitation in a manic patient?
Increased mood stabilization
What is the primary mechanism of action of lithium in treating manic patients?
Modulation of cellular signaling
What is the main limitation of using lithium for mood stabilization?
Narrow therapeutic margin
Why is frequent monitoring necessary when using lithium?
To detect potential adverse effects
What is the range of serum levels required for lithium to be effective?
A narrow range between minimally effective and minimally toxic concentrations
What is the significance of the lithium toxicity meter?
It shows the narrow range between minimally effective and minimally toxic concentrations
Why is lithium useful for stabilizing mood after the acute mania is managed?
It can help regulate dysregulated pathways
What is the main advantage of using lithium in patients who are adherent to follow-up?
The benefit of treatment outweighs the risk of adverse effects
What is the primary reason for not prescribing lithium to pregnant women?
It can precipitate cardiac anomalies in the early weeks of pregnancy.
What is the purpose of performing a TSH test before starting lithium therapy?
To establish a baseline for future monitoring.
How frequently should lithium levels be monitored when first starting therapy?
Weekly or biweekly.
What is the primary concern when prescribing lithium to a patient who is not using contraception?
The risk of cardiac anomalies in the fetus.
What is the purpose of performing a CBC test before starting lithium therapy?
To detect undiagnosed infection or immunosuppression.
Why is it recommended to get a patient on some form of birth control before starting lithium therapy?
To prevent cardiac anomalies in the fetus.
What is the function of the active transport pumps in the thyroid gland?
To pump iodine into the thyroid gland
Why is iodine important for the thyroid gland?
It is required for the synthesis of thyroid hormones
What is the purpose of performing an hCG test before starting lithium therapy?
To ensure the patient is not pregnant.
What happens to the thyroid gland when high levels of iodine are present in the body?
It down regulates its iodine receptors
What is the category of lithium in terms of pregnancy?
Category X.
What is the consequence of long-term lithium therapy on the thyroid gland?
It leads to hypofunction of the thyroid gland
Why do patients on lithium therapy need to have their TSH monitored regularly?
To detect potential hypofunction of the thyroid gland
What is the treatment for hypofunction of the thyroid gland caused by lithium therapy?
Administering thyroid hormone replacement
What is the purpose of iodizing salt?
To prevent iodine deficiency
What is lithium composed of?
Iodine and other elements
Study Notes
Patient's Psychiatric History
- The patient, now 57, had been diagnosed with anxiety and depression decades ago, prior to her marriage.
- She was treated with sertraline and felt it helped a little, but stopped taking it a year later when she felt her life had normalized.
- She had no meaningful psychiatric care until six years ago when she was diagnosed with bipolar disorder following a manic episode.
- She believes her mania began with menopause, which was early onset, and that her mood elevations started around that time.
Medical History
- The patient has a diagnosis of hyperthyroidism and takes levothyroxine.
- She has osteoporosis and is on a bisphosphonate from her primary care provider.
- She has a diagnosis of dyslipidemia but is not taking any medications for it.
- She reports chronic nausea and vomiting, for which she takes ondansetron, 8 milligrams BID.
Lithium Therapy
- Lithium is one of the most powerful antimanic drugs, useful for stabilizing mood after the acute mania is managed.
- It appears to do several things, including modulating cellular signaling and regulating dysregulated pathways.
- However, there are significant safety issues and monitoring requirements, including the potential for very serious and lethal adverse effects.
- The patient needs to have lithium levels regularly monitored to ensure they stay within the therapeutic range.
- Lithium can cause thyroid hypofunction, so TSH needs to be monitored every 12 weeks.
Lithium and Pregnancy
- Lithium is pregnancy category X and should not be given to somebody who is contemplating pregnancy, trying to get pregnant, or not using any form of contraception while sexually active.
- It can precipitate cardiac anomalies in the early weeks of pregnancy.
Laboratory Panel for Lithium Therapy
- A basic metabolic panel is needed to ensure no undiagnosed renal dysfunction.
- A CBC is needed to ensure no undiagnosed infection or immunosuppression.
- A TSH is needed as a baseline to monitor for thyroid hypofunction.
- An hCG is needed to ensure the patient is not pregnant.
- Lithium levels will be monitored regularly when starting therapy.
A patient discusses her current feelings of depression and low energy, sharing her past experiences with anxiety and depression. The conversation explores her psychiatric history and situational factors that may have contributed to her mental health.
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