Lithium and pregnancy - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 3 Forum

USMLE Step 3 Forum USMLE Step 3 Discussion Forum: Let's talk about anything related to USMLE Step 3 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-11-2013
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,316 Times in 706 Posts
Reputation: 1331
Question Lithium and pregnancy

Hi all, I have done my fair share of research and I havent found a concise answer about this and I would like to ask for everyone's help.

The thing is this.. Both MTB 3 and Kaplan Lecture notes say that in pregnancy you discontinue Lithium and if there is an acute manic episode during the first trimester you treat with ECT; and from the 2nd trimester onward you use Lamotrigine.

However I remember uworld stated that you dont discontinue the drug, you just divide the doses and decrease them a little bit + you do a cardiac ECHO at 14-18 weeks to screen for the famous Ebstein anomaly.
Here is the link from uworld: http://www.educus.com/Journals/SrchD...ookieSupport=1

So what would you answer on the exam? this topic is quite weird
Reply With Quote Quick reply to this message
The above post was thanked by:
K06100 (06-11-2013), vita86 (11-25-2014)



  #2  
Old 07-04-2013
USMLE Forums Scout
 
Steps History: 1+CK+CS+3
Posts: 62
Threads: 21
Thanked 21 Times in 14 Posts
Reputation: 31
Default

If the pt is planning pregnancy its best to discontinue Li. But if she is already in her 2nd trimester and was on Li there in no benefit from discontinuing it because whatever damage it could have possibly caused wud have already been caused in the first trimester ... in that case u can try lowering the dose and screening for Ebstein's.
Reply With Quote Quick reply to this message
The above post was thanked by:
im99 (07-12-2013), Noa2013 (06-19-2015), XpaezX (07-04-2013)
  #3  
Old 07-12-2013
USMLE Forums Scout
 
Steps History: Not yet
Posts: 70
Threads: 5
Thanked 13 Times in 10 Posts
Reputation: 23
Default

Quote:
Originally Posted by Pectoralis86 View Post
If the pt is planning pregnancy its best to discontinue Li. But if she is already in her 2nd trimester and was on Li there in no benefit from discontinuing it because whatever damage it could have possibly caused wud have already been caused in the first trimester ... in that case u can try lowering the dose and screening for Ebstein's.

Lowering? for what?
The damage will be done already. Damage is done in the first month.
Just continue if damage is done but record properly if the baby was affected, be eco/cardio. I think.
Reply With Quote Quick reply to this message
  #4  
Old 07-14-2013
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,316 Times in 706 Posts
Reputation: 1331
Default

Quote:
Originally Posted by Pectoralis86 View Post
If the pt is planning pregnancy its best to discontinue Li. But if she is already in her 2nd trimester and was on Li there in no benefit from discontinuing it because whatever damage it could have possibly caused wud have already been caused in the first trimester ... in that case u can try lowering the dose and screening for Ebstein's.

Yeah, thats what I was figuring.. I hope they dont put both options in the exam.. or probably is a different area of the same spectrum

I would analyze it like this:
  1. If pt not pregnant and wants to get pregnant, discontinue Lithium and proceed with ECT in case of acute manic episode during 1st trimester or start lamotrigine from the 2nd trimester onward.
  2. Pt already pregnant, titrate lithium dosage and do serial ECHO's to check for Ebstein anomaly.
Thats the conclusion I'm having about this.. Thanks for your help guys!
Reply With Quote Quick reply to this message
The above post was thanked by:
vita86 (11-25-2014)
  #5  
Old 08-18-2013
USMLE Forums Scout
 
Steps History: Not yet
Posts: 70
Threads: 5
Thanked 13 Times in 10 Posts
Reputation: 23
Default

Quote:
Originally Posted by XpaezX View Post
Yeah, thats what I was figuring.. I hope they dont put both options in the exam.. or probably is a different area of the same spectrum

I would analyze it like this:
  1. If pt not pregnant and wants to get pregnant, discontinue Lithium and proceed with ECT in case of acute manic episode during 1st trimester or start lamotrigine from the 2nd trimester onward.
  2. Pt already pregnant, titrate lithium dosage and do serial ECHO's to check for Ebstein anomaly.
Thats the conclusion I'm having about this.. Thanks for your help guys!
That is not what kaplan q bank says. I choose an option for continue the lithium because the patient was already 10 weeks ... so almost at the end of the frist trimester.. but I was incorrecto according to them.. they expected me to choose ECT. oVER there I read that if the patient is very well stabilized for years with a drug and if it is pretty much already late to stop the drug... then it might be smart to just continue the drug. At the end of the day it is only 1% of possiblity of ebstein.
Reply With Quote Quick reply to this message
  #6  
Old 08-18-2013
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,316 Times in 706 Posts
Reputation: 1331
Default

Quote:
Originally Posted by Chemole View Post
That is not what kaplan q bank says. I choose an option for continue the lithium because the patient was already 10 weeks ... so almost at the end of the frist trimester.. but I was incorrecto according to them.. they expected me to choose ECT. oVER there I read that if the patient is very well stabilized for years with a drug and if it is pretty much already late to stop the drug... then it might be smart to just continue the drug. At the end of the day it is only 1% of possiblity of ebstein.
You need to improve your reading skills.

Nowhere in my 2 posts did I mention Kaplan QBANK, I mentioned Kaplan Lecture NOTES USMLEWORLD and quoted a USMLEWORLD EDUCUS ARTICLE (im putting it like this so you understand).
Reply With Quote Quick reply to this message
  #7  
Old 08-18-2013
USMLE Forums Scout
 
Steps History: Not yet
Posts: 70
Threads: 5
Thanked 13 Times in 10 Posts
Reputation: 23
Default

Indeed...I know what you put.
The thing is....in kaplan step 3 qbank where it is stated that we should stop it, but they give a case where the patient is pretty much at the end of the first trimester and chronically well managed with lithium.

I did choose "continue lithium" (since it is already late, very late to care about the 1% of possiblity of an ebstein), and therefore, ...withdrawing the drug would be no longer convenient. ECT is not a happy thing to begin with, and should be used in particular cases like emergencies.

I did choose that option instead of withdraw the drug plus ECT because I read over there that if the patient was chronically on a drug and successfully, and if it is late enough... (as in kap example) then it would be worthless to stop the drug and perhaps innecesary.

I already finished uworld qbank, fischer book and now I am in kaplan qbank.. that is why I feel bad because I am still doubting on this.
The day of my exam, september 2nd, I would mark ECT anyway
Reply With Quote Quick reply to this message
  #8  
Old 08-18-2013
Kais_MD's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 299
Threads: 26
Thanked 177 Times in 103 Posts
Reputation: 187
Default

Quote:
Originally Posted by XpaezX View Post
Hi all, I have done my fair share of research and I havent found a concise answer about this and I would like to ask for everyone's help.

The thing is this.. Both MTB 3 and Kaplan Lecture notes say that in pregnancy you discontinue Lithium and if there is an acute manic episode during the first trimester you treat with ECT; and from the 2nd trimester onward you use Lamotrigine.

However I remember uworld stated that you dont discontinue the drug, you just divide the doses and decrease them a little bit + you do a cardiac ECHO at 14-18 weeks to screen for the famous Ebstein anomaly.
Here is the link from uworld: http://www.educus.com/Journals/SrchD...ookieSupport=1

So what would you answer on the exam? this topic is quite weird
I think in the begining you are suppose to stop it and do ECT if she needs it. Kaplan says the same thing and 2nd and 3rd trimester with lamotrigine. I have never heard of decreasing the dose. it also makes sense to stop it and not decrease the dose because lithium has a very narrow therapeutic index....
__________________
Always Remember (The Devil is in the Details) @_@
Reply With Quote Quick reply to this message
  #9  
Old 06-19-2015
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 22
Threads: 4
Thanked 13 Times in 8 Posts
Reputation: 23
Default

The damage hasn't 'already been done'. We can't reduce the risk of Ebstein's Anomaly, you're right, but by tapering Lithium down we decrease the risk of:
1- Cretinism
2- Transient Neuromuscular dysfunction
Both are problems associated with the use of Lithium in the 2nd and 3rd trimesters of pregnancy.
__________________
"There's always a siren singing you to shipwreck."
Reply With Quote Quick reply to this message
  #10  
Old 07-19-2015
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 11
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Default

So what is the conclusion?

Discontinue Li if pt wants to be pregnant, do ECT if needed and add lamotrigene 2nd and 3rd trimester?
or contine Li but titrated?
Reply With Quote Quick reply to this message
  #11  
Old 04-08-2016
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 25
Threads: 9
Thanked 1 Time in 1 Post
Reputation: 11
Default

hehe now it is 2016 ..
I started my step 3 preparation and I am confused about this topic also.
what i know that we should continue lithium in pregnancy , it is considered 1st choice despite being category D but the risk is acceptable given the problem of mania. Although ECT is safe with the only problem being fetal arythmia but is not sufficient alone as monotherapy for mood stabilization.
I will keep her on lithium and do an echo on 14 weeks gestation..
Reply With Quote Quick reply to this message



Reply

Tags
ObGyn-, Toxicology-

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
cause of Lithium toxicity stfidel USMLE Step 2 CK Forum 3 03-05-2013 02:38 PM
Lithium can be used in pregnancy.. struggle USMLE Step 1 Forum 6 06-19-2011 04:43 AM
some facts about lithium INCOGNITO USMLE Step 1 Bits & Pieces 4 06-13-2011 06:40 AM
Lithium Mnemonic! anila USMLE Step 1 Mnemonics 0 12-11-2010 04:49 AM
Side effects of Lithium jackat1000 USMLE Step 1 Mnemonics 0 01-18-2010 09:33 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)