Psychiatric Medications Q 33
Nurse Krina knows that the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD):
A. benztropine (Cogentin) and diphenhydramine (Benadryl).
B. chlordiazepoxide (Librium) and diazepam (Valium)
C. fluvoxamine (Luvox) and clomipramine (Anafranil)
D. divalproex (Depakote) and lithium (Lithobid)
Correct Answer: C. fluvoxamine (Luvox) and clomipramine (Anafranil)
The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD. Historically the tricyclic antidepressant (TCA) clomipramine was used as the first-line for OCD due to its strong predilection for serotonin. However, given the side effect profile, SSRIs have gained favor. OCD is most commonly treated with SSRIs, and at much higher doses than used to treat anxiety or depression. FDA-approved SSRIs include fluoxetine, fluvoxamine, paroxetine, and sertraline.
Option A: Benztropine belongs to the synthetic class of muscarinic receptor antagonists (anticholinergic drugs). Thus, it has a structure similar to that of diphenhydramine and atropine. However, it is long-acting so that its administration can be with less frequency than diphenhydramine. Diphenhydramine, which is available as an over-the-counter medication, is a first-generation antihistamine that is used in a variety of conditions to treat and prevent dystonias, insomnia, pruritus, urticaria, vertigo, and motion.
Option B: Librium and Valium may be helpful in treating anxiety-related to OCD but aren’t drugs of choice to treat the illness. Chlordiazepoxide is a long-acting benzodiazepine and is an FDA-approved medication for adults with mild-moderate to severe anxiety disorder, preoperative apprehension and anxiety, and withdrawal symptoms of acute alcohol use disorder. Diazepam is an anxiolytic benzodiazepine, first patented and marketed in the United States in 1963. It is a fast-acting, long-lasting benzodiazepine commonly used in the treatment of anxiety disorders, as well as alcohol detoxification, acute recurrent seizures, severe muscle spasm, and spasticity associated with neurologic disorders.
Option D: Divalproex sodium is a stable coordination compound comprised of sodium valproate and valproic acid used to treat manic episodes associated with bipolar disorder, epilepsy, and migraine headaches. Lithium was the first mood stabilizer and is still the first-line treatment option, but is underutilized because it is an older drug. Lithium is a commonly prescribed drug for a manic episode in bipolar disorder as well as maintenance therapy of bipolar disorder in a patient with a history of a manic episode. The primary target symptoms of lithium are mania and unstable mood.