Updated: 6/23/2021

Lithium

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
5
0
0
0%
0%
Evidence
4
0
0
Topic
Overview
  • Psychiatric medications can be broken down into the following categories
    • antidepressants
    • antipsychotics
    • mood stabilizers
      • include lithium
    • anxiolytics
Mechanism
  • Mood stabilizer
  • Mechanism
    • unknown
    • may be related to inhibition of phosphoinositol recycling in neurons
Indications
  • Clinical use
    • mood disorders
      • bipolar disorder 
        • for acute treatment of mood episodes and maintenance therapy (prevention of future episodes) 
      • major depressive disorder (MDD)
        • adjunctive treatment for some patients who have failed treatment with an antidepressant alone
      • reduces suicide risk in bipolar disorder and MDD 
    • SIADH
Toxicity and Side Effects
  • Toxicity
    • very narrow therapeutic index
      • requires blood monitoring
      • toxicity may be seen at levels higher than 1.5 mEq/L
      • increased risk in patients who are volume depleted or hyponatremic
      • caution if adding hydrochlorathiazide, NSAID, or ACE-inhibitor
      • loop diuretics do not increase toxicity
    • tremor (coarse tremor indicates likely toxicitiy)
    • sedation
    • ataxia
    • acne
    • edema
    • heart block
    • exclusively excreted by the kidneys (reabsorbed at the proximal convoluted tubule with Na+) and long term use may cause a glomerulopathy
    • hyperparathroidism 
    • hypothyroidism 
    • polyuria  
      • ADH antagonist resulting in nephrogenic diabetes insipidus
      • reason for use in SIADH
    • leukocytosis
    • teratogenesis if given in pregnancy
      • cardiac malformations including Ebstein anomaly in first trimester   

Please rate topic.

Average 5.0 of 2 Ratings

Questions (5)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M1.PY.15.75) A 19-year-old African American male with a history of bipolar I disorder presents to the psychiatrist for a follow-up visit. During the session, the patient explains that for the past 2 months he has felt significantly fatigued and constipated. He is always complaining of feeling cold and has gained several pounds although his diet has not changed. A blood sample was sent for analysis, revealing the following: TSH - 6 mIU/L (nl = 0.4-4.0 mIU/L), free T4 - 0.4 ng/dL (nl = 0.7-1.9 ng/dL), and serum T4 - 2.1 mcg/dL (nl = 4.6-12 mcg/dL). Which of the following is responsible for these abnormalities?

QID: 106839
1

Valproic acid

12%

(6/50)

2

Lithium

78%

(39/50)

3

Carbamazepine

4%

(2/50)

4

Lamotrigine

0%

(0/50)

5

Olanzapine

4%

(2/50)

M 3 C

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M1.PY.13.109) A 27-year-old P1G1 who has had minimal prenatal care delivers a newborn female infant. Exam reveals a dusky child who appears to be in distress. Her neck veins are distended and you note an enlarged v wave. She has a holosystolic murmur. Following echocardiogram, immediate surgery is recommended.

For which of the following conditions was the mother likely receiving treatment during pregnancy?

QID: 100625
1

Depression

3%

(5/145)

2

Hypothyroidism

6%

(9/145)

3

Diabetes

10%

(14/145)

4

Bipolar disorder

77%

(111/145)

5

Hypertension

2%

(3/145)

M 4 E

Select Answer to see Preferred Response

Evidence (4)
EXPERT COMMENTS (14)
Private Note