Use of which medications to treat headaches has been associated with the development of medication overuse headaches (MOH): (Select all that apply)

Lithium is a narrow therapeutic index mood stabilizer commonly used in the treatment of bipolar disorder. Early in therapy, patients may experience mild gastrointestinal side effects such as nausea, abdominal discomfort, and bloating as the body adjusts to the medication. Therapeutic levels must be carefully monitored because toxicity can occur with small increases in serum concentration. Clinical decisions are guided by serum levels, symptom severity, and signs of toxicity.

Rationale:
A. Contacting the prescriber to request serum electrolytes is not the priority because lithium therapy is already being appropriately monitored with a therapeutic level provided. While electrolytes may be assessed in some situations, mild gastrointestinal side effects without toxicity do not warrant immediate additional lab testing.

B. Administering the dose and reassuring the patient is appropriate because a lithium level of 0.8 mEq/L is within the therapeutic range (generally 0.6–1.2 mEq/L for maintenance). Mild nausea and abdominal bloating are common early side effects that typically improve with continued therapy. Taking the medication with food or adjusting timing can also help reduce gastrointestinal discomfort.

C. Requesting an order for amiloride (Midamor) is not indicated in this situation. Amiloride is sometimes used in lithium management to reduce renal lithium reabsorption in specific cases of toxicity or nephrogenic diabetes insipidus. The patient has a therapeutic level and only mild expected side effects, so this intervention is unnecessary.

D. Holding the dose and notifying the prescriber is inappropriate because there are no signs of lithium toxicity and the serum level is within therapeutic range. Toxicity would present with symptoms such as coarse tremors, confusion, vomiting, or ataxia, which are not present here. Interrupting therapy could destabilize mood control unnecessarily.

Depot (long-acting injectable) antipsychotics are used in the long-term management of schizophrenia to improve medication adherence and maintain stable therapeutic drug levels. These formulations are administered intramuscularly at extended intervals ranging from weeks to months. They are especially useful in patients with poor adherence to oral therapy or recurrent relapses. These medications include both first- and second-generation antipsychotics formulated for sustained release.

Rationale:
A. Amantadine (Symmetrel) is an antiviral and antiparkinsonian medication used to treat influenza A and drug-induced extrapyramidal symptoms. It is not an antipsychotic and has no depot injectable formulation for schizophrenia maintenance therapy. It is not classified as a long-acting antipsychotic.

B. Clozapine is a second-generation antipsychotic used for treatment-resistant schizophrenia and reducing suicidal risk. However, it is only available in oral form due to the risk of agranulocytosis requiring frequent blood monitoring. It does not have a depot injectable formulation.

C. Aripiprazole (Abilify) is available in long-acting injectable form for maintenance treatment of schizophrenia and bipolar disorder. The depot formulation allows sustained dopamine partial agonist activity, improving adherence and symptom stability over time. It is a recognized second-generation depot antipsychotic.

D. Risperidone microspheres (Risperdal Consta) is a long-acting injectable second-generation antipsychotic used for maintenance therapy in schizophrenia. It is administered every two weeks and provides steady plasma levels to reduce relapse risk. It is one of the most commonly used depot formulations.

E. Haloperidol decanoate is a long-acting first-generation antipsychotic used for maintenance treatment of schizophrenia. It provides extended dopamine blockade and is typically administered every 4 weeks. It is widely used in patients requiring long-term adherence support.

F. Olanzapine pamoate (Zyprexa) is a long-acting injectable second-generation antipsychotic used for schizophrenia maintenance therapy. It has a risk of post-injection delirium/sedation syndrome, requiring monitoring after administration. Despite this risk, it is an approved depot formulation.