Psychiatric Medications Q 71
Nurse Maureen knows that the non-antipsychotic medication used to treat some clients with schizoaffective disorder is:
A. phenelzine (Nardil)
B. chlordiazepoxide (Librium)
C. lithium carbonate (Lithane)
D. imipramine (Tofranil)
Correct Answer: C. lithium carbonate (Lithane)
Lithium carbonate, an antimanic drug, is used to treat clients with cyclical schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes affective symptoms, including manic-like activity. Lithium helps control the affective component of this disorder. 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.
Option A: Phenelzine is a monoamine oxidase inhibitor prescribed for clients who don’t respond to other antidepressant drugs such as imipramine. Phenelzine is an FDA-approved drug for the management of depression in adults. Off label, the drug may be used for the management of treatment-resistant depression, panic disorder, and social anxiety disorder. Phenelzine is also specifically useful for young women who have depression and mood disorders. Research has not established the safety and efficacy for children or adolescents.
Option B: Chlordiazepoxide, an antianxiety agent, generally is contraindicated in psychotic clients. 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. It is also FDA approved for pediatric patients greater than six years old for anxiety.
Option D: Imipramine, primarily considered an antidepressant agent, is also used to treat clients with agoraphobia and those undergoing cocaine detoxification. Imipramine is a tertiary amine tricyclic antidepressant. Tricyclic antidepressants (TCAs) had been approved by the Food and Drug Administration (FDA) as antidepressants in the 1950s. Although it is FDA approved for the treatment of depression, it is a second-line treatment notably in severe depression with melancholic and atypical features, due to its undesirable side effects and due to its toxicity in overdose.