Lithium

Question 1

What is lithium’s primary clinical use?

Answer 1

Gold standard mood stabilizer for acute mania and maintenance in bipolar disorder

Question 2

One unique benefit of lithium compared to other mood stabilizers

Answer 2

Reduces suicidal ideation and behavior

Question 3

Is lithium neuroprotective?

Answer 3

Yes — evidence supports neuroprotective effects in bipolar disorder

Question 4

Lithium’s therapeutic index is best described as:

Answer 4

Narrow (low margin between therapeutic and toxic levels)

Question 5

Therapeutic lithium level (maintenance)

Answer 5

0.6–1.2 mEq/L

Question 6

Therapeutic lithium level (acute mania)

Answer 6

0.8–1.2 mEq/L

Question 7

At what level does lithium toxicity begin?

Answer 7

≥ 1.5 mEq/L

Question 8

When should lithium levels be drawn?

Answer 8

12 hours post-dose (trough level)

Question 9

Baseline labs required before starting lithium

Answer 9

TSH
Serum creatinine
BUN
Pregnancy test (HCG)
ECG if > 50 years

Question 10

Why monitor thyroid function with lithium?

Answer 10

Risk of hypothyroidism

Question 11

Why monitor renal function with lithium?

Answer 11

Lithium is renally excreted → toxicity risk with renal impairment

Question 12

Long-term monitoring labs for lithium therapy

Answer 12

CBC
Renal function
Thyroid & parathyroid (TSH, calcium)

Question 13

Common CNS side effects of lithium

Answer 13

Fine hand tremor
Fatigue
Mental cloudiness
Headache

Question 14

Common endocrine side effects of lithium

Answer 14

Weight gain
Hypothyroidism

Question 15

Common GI side effects of lithium

Answer 15

Nausea
Diarrhea
Vomiting
Cramps
Anorexia

Question 16

Dermatologic side effects of lithium

Answer 16

Acne
Pruritus
Maculopapular rash

Question 17

Hematologic side effect of lithium

Answer 17

Leukocytosis

Question 18

Early signs of lithium toxicity

Answer 18

GI upset (severe N/V, diarrhea)
Confusion
Drowsiness

Question 19

Neurologic signs of lithium toxicity

Answer 19

Coarse hand tremors
Ataxia
Slurred speech
Blurred vision
Nystagmus

Question 20

Difference between lithium tremors

Answer 20

Fine tremor = common side effect
Coarse tremor = toxicity

Question 21

Cardiac toxicity signs of lithium

Answer 21

T-wave inversion
Dysrhythmias

Question 22

Immediate action if lithium toxicity is suspected

Answer 22

Stop lithium immediately and check serum level

Question 23

What increases lithium levels?

Answer 23

Anything that decreases sodium or renal excretion

Question 24

Medications that increase lithium levels

Answer 24

Thiazide diuretics
NSAIDs
ACE inhibitors
ARBs
Caution with loop diuretics

Question 25

Which pain relievers do NOT increase lithium levels?

Answer 25

Aspirin (ASA) and acetaminophen (Tylenol)

Question 26

Why do NSAIDs increase lithium levels?

Answer 26

Prostaglandin inhibition → ↓ renal lithium clearance

Question 27

Renal side effects of lithium

Answer 27

Polyuria Polydipsia Nephrogenic diabetes insipidus Edema

Question 28

Why must patients maintain adequate hydration on lithium?

Answer 28

Dehydration → ↑ lithium levels → toxicity

Question 29

Lithium and anorexia nervosa share which side effect?

Answer 29

Peripheral edema

Question 30

Lithium is contraindicated in pregnancy because it causes:

Answer 30

Ebstein anomaly (cardiac defect)

Question 31

Lithium pregnancy category

Answer 31

Category D

Question 32

Lithium and breastfeeding category

Answer 32

L3 (moderately safe) — caution required

Question 33

L3 (moderately safe) — caution required

Answer 33

Rapid-cycling bipolar disorder

Question 34

Typical response time for lithium

Answer 34

1–2 weeks

Question 35

Typical lithium dosing (acute mania)

Answer 35

1,200–2,400 mg/day

Question 36

Typical lithium dosing (maintenance)

Answer 36

900–1,200 mg/day

Question 37

Key patient education for lithium therapy

Answer 37

Maintain consistent salt & fluid intake Avoid dehydration Report GI symptoms, confusion, tremors Regular lab monitoring required

Question 38

Women of childbearing age on lithium must be educated about what?

Answer 38

Effective contraception

Question 39

Lithium Safety Rules to Remember

Answer 39

Narrow window, kidneys matter, sodium matters Draw levels at 12-hour trough; toxicity starts ≥ 1.5 mEq/L