The drug of choice for the treatment of manic episode is?

UPRVUNL - 2021

Pharmacology

Easy

Appeared in: UPRVUNL - 2021

Explanation

Lithium is the classic mood-stabilizing agent and is considered the gold standard and first-line drug for treating acute mania and for maintenance therapy in bipolar disorder.
It effectively reduces core manic symptoms like euphoria, hyperactivity, and flight of ideas, although its therapeutic effect may take 1-2 weeks to develop.
Unlike antipsychotics which primarily manage agitation, Lithium targets the underlying mood instability, preventing future episodes of both mania and depression.

Option A: Haloperidol is a typical antipsychotic. While it is frequently used in acute mania, its purpose is to rapidly control severe agitation, aggression, and psychotic symptoms, not to act as a primary mood stabilizer.
Option B: Imipramine is a tricyclic antidepressant (TCA). Administering an antidepressant to a patient in a manic or mixed state is contraindicated as it can worsen manic symptoms or precipitate a switch into mania.
Option C: CPZ (Chlorpromazine) is a low-potency typical antipsychotic. Like Haloperidol, it can be used for its sedative effects to manage agitation in acute mania, but it is not the specific drug of choice for mood stabilization and has a higher burden of side effects (like sedation and hypotension) compared to newer agents.

Clinical Relevance

Nursing practice connection: Knowing Pharmacological Management of Mania helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
The nurse's role in lithium therapy is critical for patient safety due to the narrow therapeutic index. This includes patient education on diet (consistent salt/fluid), medication adherence, and the absolute necessity of regular blood monitoring.
Early recognition of lithium toxicity is a key nursing responsibility. A change from fine to coarse hand tremors is a classic warning sign that requires immediate reporting and intervention.
What if? If a patient on lithium develops severe diarrhea and vomiting from a stomach flu, the nurse must recognize this as a high-risk situation for lithium toxicity due to dehydration and sodium loss. The immediate action is to hold the lithium dose and notify the physician for orders, likely including a stat serum lithium level.

How to Approach the Question

First, identify the key condition in the question stem: 'manic episode'.
Next, analyze the options provided and classify them by drug class. Haloperidol and CPZ are antipsychotics, Imipramine is an antidepressant, and Lithium is a mood stabilizer.
Recall the primary treatment goal for a manic episode, which is mood stabilization, not just sedation or treating depression.
Recognize that Lithium is the classic, first-line mood stabilizer for mania.
Eliminate the antidepressant (Imipramine) as it is contraindicated in mania.
Differentiate the role of antipsychotics (Haloperidol, CPZ) as agents for acute agitation versus the role of a mood stabilizer (Lithium) as the definitive treatment for the underlying condition. This makes Lithium the 'drug of choice'.

Concept Tested & Keywords

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E6 Pharmacology KD Tripathi Essentials 9e Part 2 pp. 118-120, 115-117

E6 Pharmacology Katzung 16e p. 824-826