A patient has been taking paroxetine (Paxil) for major depressive ...

[arivle123]

A patient has been taking paroxetine (Paxil) for major depressive symptoms for 8 months. The patient tells the primary care NP that these symptoms improved after 2 months of therapy.
 
  The patient is experiencing weight gain and sexual dysfunction and wants to know if the medication can be discontinued. The NP should: a. change to a tricyclic antidepressant medication.
  b. begin to taper the paroxetine and instruct the patient to call if symptoms increase.
  c. tell the patient to stop taking the medication and to call if symptoms get worse.
  d. continue the medication for several months and consider adding bupropion (Wellbutrin).

Question 2

A patient has been taking ciprofloxacin for 3 days and calls the primary care nurse practitioner (NP) to report having headaches and dizziness. The NP should:
 
  a. change to levofloxacin.
  b. decrease the dose of ciprofloxacin.
  c. change to an antibiotic in another drug class.
  d. reassure the patient that these are common side effects.

[scottmt]

Answer to Question 1

D
Once a patient achieves remission, a continuation phase of 16 to 20 weeks followed by a maintenance phase of 4 to 9 months should be carried out. Some responders, called apathetic responders, may have a decrease in most symptoms but continue to have lack of pleasure, decreased libido, and lack of energy. Bupropion can be added to therapy to treat these symptoms. Patients should not change medications during this phase, should not begin a drug taper, and should never stop the medication abruptly.

Answer to Question 2

D
Headaches and dizziness are common side effects of fluoroquinolones. It is not necessary to change to another fluoroquinolone, decrease the dose, or change to another antibiotic class.

[arivle123]

Excellent

[coreycathey]

Gracias!