Lithium

  -is an element which is the smallest alkali ion .
Discovered by Arfuedson in 1817 and is used for the treatment of gout , cardiac disease but has fatal toxicity .
Then it is used in treatment of mania . Often called as antimanic and also as mood stabilizing agent .
Indications - 1 treatment of acute mania 2 prophylaxis of bipolar mood disorder 3 prophylaxis of unipolar mood disorder 4 treatment of cyclothymia  5 treatment of acute depression 6 treatment of impulsive aggression  7 cluster headache , cyclical vomiting , hyperthyroidism .
Pharmacokinetics - very rapidly absorbed from GI tract. Peak betn 30min to 3hrs . It is not protein bound . There is no metabolism of lithium in the body and excreted entirely by kidneys .
Mechanism of action -
1 it affects Na-K ATPase and accumulates intracellularly as a substitute of Na .
2 it inhibits adenylate cyclase and decrese cAMP 3 accelerates the presynaptic reuptake .
4 inhibit release of catecholamines at synap
5 stebilizes the cell membrane .
Clinical use -
Preparations - 1 lithium carbonate 300mg and 400mg sustain release
2 lithium citrate 300mg or 5ml liquid .
Investigate at repeated intervals when pt is started on it like , CBC , RFT , TFT , EKG , URINE .
Side effects - A neuro-.1tremor 2 muscular weakness 3 cogwheel rigidity 4 seizures .
B renal - 1 polyuria ,polydipsia 2 tubular changes 3 nephrogenic DI 4 nephrotic syndrome
C cvs -t wave depresion in EKG .
D endocrine - 1 goitre 2 hypothyroidism 3wt gain
E GI -nausea , vomiting , diarrhea , abdo pain .
F teratogenicity during pregnancy .
Contraindications - 1 presence of cardic , renal , thyroid disease .
2 blood dyscrasia .
3 during first trimester of pregnancy and lactation