Lithium

Uses

Very very effective, but dangerous.

 

Mechanism

 

 

Dose and Half Life

Monitoring Lithium Therapy

baseline labs: renal functioning, TSH

obtain serum levels 5 days after the most recent dose titration

ECG

 

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Adverse Drug Reactions

Lithium toxicity is bad news: follow lithium blood levels and drink lots of water.

 

CNS: fatigue, dysphoria, fine tremor

GI: nausea, vomiting, diarrhea, weight gain

CVS: benign T wave changes, sinus

Nephrotoxicity

can damage kidneys (1:500-1:1000)

Lithium collects in the collecting tubules, where it can lead to ADH resistance. This should be avoided in combination with other drugs causing volume depletion or which prevent the kidneys from compensating.

Chronic interstitial nephritis can occur in 15-20% of long term users of lithium.

Nephrotic syndrome (minimal change disease or focal segmental glomerulosclerosis can occur.

Renal tubular acidosis can follow reduced activity of H+ ATPase in collecting tubule.

endocrine: hypothyroidism, hypoparathyroidism

Other symptoms include cognitive impairment, tremor, acne, psoriasis, polydypsia, polyuria, edema, nausea and vomiting.

benign leukocytosis

4-12% rate of congenital malformations: Epbstein anomaly, polyhydramnios, preterm delivery

 


Lithium Toxicity and Overdose

Toxicity is usually chronic, though acute overdose is always possible. Precipitants include renal failure or dehydration.

manifestations include:

Treatment includes supportive measures, hypotonic IV, and hemodialysis if levels are over 4 or with significant symptoms

 


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Counter-Indications and Drug Interactions

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Metabolism and Excretion

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Dependency

 

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