Lithium – Psychiatric Usage

LITHIUM – PSYCHIATRIC USAGE

Q. 1 Treatment of choice in acute Bipolar disorder
 A Valproate
 B Lamotrigine
 C Lithium
 D All of the above
Q. 1 Treatment of choice in acute Bipolar disorder
 A Valproate
 B Lamotrigine
 C Lithium
 D All of the above
Ans. C

Explanation:

Lithium


Q. 2 Lithium is not used in treatment of which of the following?
 A Major depression
 B Vascular headache
 C Neutropenia
 D Generalized anxiety disorder
Q. 2 Lithium is not used in treatment of which of the following?
 A Major depression
 B Vascular headache
 C Neutropenia
 D Generalized anxiety disorder
Ans. D

Explanation:

Generalized anxiety disorder


Q. 3

Which of the following represent the theraputic level of Lithium in serum?

 A

0.8 – 1.2 meq/l

 B

0.6 – 1.2 meq/l

 C

>2 meq/l

 D

None

Q. 3

Which of the following represent the theraputic level of Lithium in serum?

 A

0.8 – 1.2 meq/l

 B

0.6 – 1.2 meq/l

 C

>2 meq/l

 D

None

Ans. A

Explanation:

Lithium is most commonly used in the treatment of bipolar depression. It has a low toxic : therapeutic ratio.

The therapeutic level of Lithium in serum is 0.8 – 1.2 mEq/L.

Lithium toxicity occur when serum lithium levels exceed 1.5 to 2 mEq/L.

Hence frequent bood tests are done to monitor the drug levels.

Lithium is fully metabilised by the kidney. Hence, dehydration could cause the drug levels to rise.

Ref: Current Medical Diagnosis and Treatment 2013, chapter 38.

Quiz In Between


Q. 4

The current agent of choice for treatment of bipolar affective (manic-depressive) disorder is:

 A

Chlorpromazine

 B

Haloperidol

 C

Diazepam

 D

Lithium carbonate

Q. 4

The current agent of choice for treatment of bipolar affective (manic-depressive) disorder is:

 A

Chlorpromazine

 B

Haloperidol

 C

Diazepam

 D

Lithium carbonate

Ans. D

Explanation:

Lithium carbonate is the current agent of choice, particularly during the manic phase. Because the onset of action is slow, concurrent use of antipsychotic agents such as chlorpromazine or haloperidol may be necessary to control mania.
Concurrent use of tricyclic antidepressants may be necessary in the depressive phase.
Monitoring of lithium levels is necessary because of the serious nature of the adverse effects (neurologic, renal, cardiac).
 
Ref: Ropper A.H., Samuels M.A. (2009). Chapter 57. Depression and Bipolar Disease. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor’s Principles of Neurology, 9e.

Q. 5

Manic-depressive illness.Which is the the most appropriate pharmacotherapeutic agent?

 A

Triazolam

 B

Tranylcypromine

 C

Methylphenidate

 D

Lithium carbonate

Q. 5

Manic-depressive illness.Which is the the most appropriate pharmacotherapeutic agent?

 A

Triazolam

 B

Tranylcypromine

 C

Methylphenidate

 D

Lithium carbonate

Ans. D

Explanation:

Lithium carbonate prevents the mood swings characteristic of manic-depressive illness and is used in long-term therapy.
Triazolam is a benzodiazepine used as a hypnotic to facilitate sleep in insomnia characterized by difficulty “falling” asleep.
Methylphenidate is an amphetamine congener with a paradoxical calming effect in children with attention-deficit hyperactivity disorder.
 
Ref: Ropper A.H., Samuels M.A. (2009). Chapter 57. Depression and Bipolar Disease. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor’s Principles of Neurology, 9e.

Q. 6

A patient with bipolar disorder started lithium therapy. The maximum therapeutic level of lithium in serum is:

 A

0.1 meq/L

 B

0.4 meq/L

 C

1.0 meq/L

 D

1.8 meq/L

Q. 6

A patient with bipolar disorder started lithium therapy. The maximum therapeutic level of lithium in serum is:

 A

0.1 meq/L

 B

0.4 meq/L

 C

1.0 meq/L

 D

1.8 meq/L

Ans. C

Explanation:

Concentrations considered to be effective and acceptably safe are between 0.6 and 1.5 mEq/L. The range of 1.0-1.5 mEq/L is favored for treatment of acutely manic or hypomanic patients. Serum concentrations of Li+ have been found to follow a clear dose-effect relationship between 0.4 and 1.0 mEq/L, but with a corresponding dose-dependent rise in polyuria and tremor as indices of adverse effects.

 
Ref: Meyer J.M. (2011). Chapter 16. Pharmacotherapy of Psychosis and Mania. In B.C. Knollmann (Ed), Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12e.

Quiz In Between


Q. 7

Lithium is treatment of choice for

 A

Unipolar MDP prophylaxis

 B

Bipolar MDP prophylaxis

 C

Schizophrenia

 D

Acute mania

Q. 7

Lithium is treatment of choice for

 A

Unipolar MDP prophylaxis

 B

Bipolar MDP prophylaxis

 C

Schizophrenia

 D

Acute mania

Ans. B

Explanation:

B i.e. Bipolar MDP prophylaxis 

Lithium: Indications:

  • Established indications:
  • Treatment of acute mania 
  • Prophylaxis of bipolar mood disorder.
  • Possible clinical indications:
    •  Treatment of the schizo-affective disorder
    •  Prophylaxis of unipolar mood ilisorder
    • treatment of cyclothymia
    • Treatment if acute depression(as an adjuvant for refractory depression)
    • Treatment of chronic akoholism(in presence of significant depressive symptoms) 6 psychoactive use disorders(e’g cocaine dePendence)
    • Treatment of impulsive aggression.
    • eatment of Keine-Levin syndrome

Q. 8

Which is the drug of choice for maintenance therapy in uncomplicated bipolar disorder ?

 A

Sodium valproate

 B

Carbamazepine

 C

Lithium

 D

Lamotrigine

Q. 8

Which is the drug of choice for maintenance therapy in uncomplicated bipolar disorder ?

 A

Sodium valproate

 B

Carbamazepine

 C

Lithium

 D

Lamotrigine

Ans. C

Explanation:

Ans. is ‘c’ i.e., Lithium

Quiz In Between


Q. 9

Drug of choice for prophylaxis of mania is

 A

Lithium

 B

Haloperidol

 C

Clozapine

 D

Carbamazepine

Q. 9

Drug of choice for prophylaxis of mania is

 A

Lithium

 B

Haloperidol

 C

Clozapine

 D

Carbamazepine

Ans. A

Explanation:

Ans. is ‘a’ i.e., Lithium


Q. 10

A patient of maniac depressive psychosis is on lithium, clozapine and fluphenazine. During the course of treatment, he developed seizures and tremors. He is drinking water heavily and had recurrent episodes of urination. Which drug is responsible for these complications:          

March 2012

 A

Lithium

 B

Clozapine

 C

Fluphenazine

 D

None of the above

Q. 10

A patient of maniac depressive psychosis is on lithium, clozapine and fluphenazine. During the course of treatment, he developed seizures and tremors. He is drinking water heavily and had recurrent episodes of urination. Which drug is responsible for these complications:          

March 2012

 A

Lithium

 B

Clozapine

 C

Fluphenazine

 D

None of the above

Ans. A

Explanation:

Ans: A i.e. Lithium

Drugs for Schizophrenia and side-effects

  • Dose related side effects of lithium includes polyuria/polydypsia, weight gain, tremor etc.
  • Common side effects of clozapine are anticholinergic, antiadrenergic etc. Potentially life threatening side effects includes fatal agranulocytosis, fatal myocarditis, fatal pulmonary embolism etc.
  • Side effect of antipsychotic, include sedation, weight gain, extra-pyramidal side effects, postural hypotension etc.

Quiz In Between



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