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    This document discusses lithium, including its mechanisms of action, therapeutic and toxic concentrations, clinical monitoring, pharmacokinetics, and examples of calculating lithium dosage. Some key points: - Lithium is used to treat bipolar disorder and works by competing with other cations and affecting neurotransmitter receptors and enzymes. - Therapeutic concentrations are 0.6-1.5 mmol/L and toxic levels above 3 mmol/L can cause severe side effects or even death. - Dosage needs to be monitored closely as lithium is excreted by the kidneys and toxicity can occur if renal function declines. - Pharmacokinetics depend on renal clearance and dosage calculations

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    This document discusses lithium, including its mechanisms of action, therapeutic and toxic concentrations, clinical monitoring, pharmacokinetics, and examples of calculating lithium dosage. Some key points: - Lithium is used to treat bipolar disorder and works by competing with other cations and affecting neurotransmitter receptors and enzymes. - Therapeutic concentrations are 0.6-1.5 mmol/L and toxic levels above 3 mmol/L can cause severe side effects or even death. - Dosage needs to be monitored closely as lithium is excreted by the kidneys and toxicity can occur if renal function declines. - Pharmacokinetics depend on renal clearance and dosage calculations

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    48 views6 pages

    Lithium

    Uploaded by

    gurrya786
    This document discusses lithium, including its mechanisms of action, therapeutic and toxic concentrations, clinical monitoring, pharmacokinetics, and examples of calculating lithium dosage. Some key points: - Lithium is used to treat bipolar disorder and works by competing with other cations and affecting neurotransmitter receptors and enzymes. - Therapeutic concentrations are 0.6-1.5 mmol/L and toxic levels above 3 mmol/L can cause severe side effects or even death. - Dosage needs to be monitored closely as lithium is excreted by the kidneys and toxicity can occur if renal function declines. - Pharmacokinetics depend on renal clearance and dosage calculations

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 6

    3/24/2012

    Lithium

    Introduction
    Lthium is an alkali metal administered as monovalent cation for treatment of bipolar disorder Theories of MOA are related to; Competition with other cations at receptor and tissue sites, dopamine receptro supersensitivity blockage, decreased stimulation of b-receptor inducted adenylate cyclase, enhanced sens: to setotonin (5-HT), acetylcholine and GABA

    3/24/2012

    Therapeutic and toxic concentration


    Therapeutic rang 0.6-1.5mmol/L (mEq/L as it is monovalent) Acute mania, min Li cocn: of 0.8 mmol/L, desired range 0.8-1 mmol/L, conc: upto 1.5mmol/L are also used Long term maintenace use 0.6-0.8mmol/L, 0.9 1.2mmol/L is used if patient dont respond

    Steady state obtained after 12hours of a dose Level to be taken after 2-3 days and 12hrs after last dose Short term side effects: muscle weakness, lethargy, polydipsia, polyuria, nocturia, headache, imparied memory, confusion, tremors

    3/24/2012

    Long term SE: drug induced diabeties, renal toxicity, hypothyroidism, ECG abnormalities, leukicytosis, weight gain, dermatological changes Cocn more than 3mmol/L cause severe toxicity, seizures, irreversible brain damage, arrythmias, hypotension, CVS complications, stupor, coma, death Toxic conc can cause non specific decrease in GFR decreasing Li clearance causes further increase in conc: Conc: above 3.5-4 mmol/L require hemodialysis

    Clinical monitoring
    Signs and symptoms of biplar disease i.e. depression and mania Onset of action 1-2 weeks and 4-6 weeks treatment period req: for complete response Complete examination and tests before therapy, follow up testing every 6 months, SE,Sr Cr, Thyroid fuction, CBC Li Cocn: every 1-2 weeks till doses are established then once in 6months

    3/24/2012

    Pharmacokinetic parameters
    Renal 95% Average Li Cl is 20% of patient Cr Cl Administered orally as carbonate or citrate salts, oral bioavailabilty 100% Not bound to plasma Typical dose of lithium carbonate is 9002400mg/d

    Cl = 0.288 (Cr Cl); Cl in L/d and Cr Cl in ml/min Acute mania: Cl = 0.432 (Cr Cl) D/ = (Css . Cl)/ F; D is Li dose in mmol;Cl in L/d, dosage interval in days; Administered in two equal divided doses 8.12 mmol Li in 300mg Li carbonate tab

    3/24/2012

    Example 1
    MJ if 50yr, 70kg male with bipolar disease. He is not currently under episode of mania. Sr Cr is 0.9mg/dl. Compute oral maintenance therapy of Li per day. Desired conc: 0.6mmol/L Cl Li = 28 L/d

    Example 1a
    MJ if 50yr, 70kg male with bipolar disease. He is not currently under episode of mania. Sr Cr is 3.5mg/dl. Compute oral maintenance therapy of Li per day. Desired conc: 0.6mmol/L

    3/24/2012

    Example 2
    MJ if 50yr, 70kg male with bipolar disease. He is being treated for acute mania. Sr Cr is 0.9mg/dl. Compute oral maintenance therapy of Li. Desired conc: 0.8mmol/L Dose = 2 tablets (600mg) twice daily

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