Prescription: Lithium

Casebank Prescription
1

Where you are
You are an FY2 in Psychiatry ward.

Who the patient is
Mr Robert Washington, aged 50, has hurt his ankle and is in severe pain.

Other information you have about the patient
He has been diagnosed with COPD.

Regular medications:
Ipratropium Bromide 20-40 microgram (1-2 puffs BD)
Atorvastatin 20mg PO OD
Lithium

What you must do
Nurse has asked you to give ibuprofen 400mg BD.

Special note
Patient is allergic to penicillin. After taking penicillin patient developed rash.

NB.

  1. Ibuprofen increases the concentration of lithium. Advises monitor and adjust dose.
  2. Both lithium and tramadol can increase the risk of serotonin syndrome.
  3. Salbutamol and Salmeterol is predicted to cause hypokalaemia (potentially
    increasing the risk of torsade de pointes) when given with lithium.
2

Where are you:
You are FY2 in psychiatry ward

Who the patient is:
Mr. Robert Washington, aged 50, has hurt his ankle and is in severe pain

Other information you have about the patient:
He has been diagnosed with COPD Regular medications:
Ipratropium bromide 20 microgram (1-2 puffs BD)
Atorvastatin 20mg PO OD
Lithium 300 mg PO OD

Special Note:
Patient is allergic to penicillin. After taking penicillin patient developed rash.

What you must do:
Write down the prescription for Ibuprofen

Case discussion

  • Ibuprofen increases the concentration of Lithium and could lead to lithium toxicity. Manufacturer advises monitor and adjust dose.
  • Diclofenac: is contraindicated in patients with the following:
  • Ischaemic heart disease
  • Peripheral arterial disease
  • Cerebrovascular accidents
  • Congestive heart failure.

Patients with the above mentioned conditions should switch to other NSAID such as Naproxen or Ibuprofen.

  • Both Lithium and NSAIDs in Renal impairment: the MHRA advises to avoid where possible; if necessary, use with caution.
  • Lithium salts have a narrow therapeutic/toxic ratio and should therefore not be prescribed unless facilities for monitoring serum-lithium concentrations are available, so write in additional info: dose adjusted according to serum-lithium concentration.