If a patient develops manic symptoms, which medication should be discontinued first according to the material?

If a patient develops manic symptoms, which medication should be discontinued first according to the material?

• A. Flonase
• B. Depakote
• C. Both
• D. None

Answer: (A)

When mania emerges, move to remove any agent that could be triggering or worsening mood symptoms. Corticosteroids, even when given as a nasal spray, can be absorbed enough to affect mood and have been associated with manic symptoms in susceptible individuals. Discontinuing the corticosteroid first targets the potential offending agent. Depakote, a mood stabilizer, is actually used to treat mania and prevent recurrence, so stopping it would counter therapeutic goals. Therefore it is not the first step. The other options aren’t appropriate because stopping nothing wouldn’t address the trigger, and stopping both would be unnecessary and potentially harmful.

When mania emerges, move to remove any agent that could be triggering or worsening mood symptoms. Corticosteroids, even when given as a nasal spray, can be absorbed enough to affect mood and have been associated with manic symptoms in susceptible individuals. Discontinuing the corticosteroid first targets the potential offending agent.

Depakote, a mood stabilizer, is actually used to treat mania and prevent recurrence, so stopping it would counter therapeutic goals. Therefore it is not the first step. The other options aren’t appropriate because stopping nothing wouldn’t address the trigger, and stopping both would be unnecessary and potentially harmful.