Author Question: A patient has been taking fluoxetine (Prozac) for depression and comes to the clinic to report ... (Read 69 times)

theo · **on:** Jul 24, 2018

A patient has been taking fluoxetine (Prozac) for depression and comes to the clinic to report nausea and jitteriness. The primary care NP notes tremors and sees that the patient is confused. The patient has a heart rate of 95 beats per minute.

The NP should: a. change to bupropion (Wellbutrin).
b. ask the patient about other medications.
c. discontinue the fluoxetine immediately.
d. add mirtazapine (Remeron) to treat anxiety.

Question 2

A patient is taking levofloxacin to treat sinusitis. The patient calls the primary care NP to report pain just above the heel of the right foot. The NP should:

a. change to ofloxacin.
b. change to ciprofloxacin.
c. discontinue the levofloxacin.
d. reassure the patient that this is a common side effect.

jojobee318 · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

B
Serotonin syndrome is a potentially lethal set of symptoms such as these. The NP should evaluate whether the patient is taking other SSRIs, monoamine oxidase inhibitors, bupropion, serotonin-norepinephrine reuptake inhibitors, or other medications that can precipitate this. Changing medication is not indicated. Patients should never abruptly discontinue an SSRI. Adding mirtazapine is not indicated.

Answer to Question 2

C
Warnings have been issued for the fluoroquinolone antibiotics for the increased risk of tendon ruptures. Ruptures have occurred unilaterally and bilaterally, and have involved the Achilles tendon; however, ruptures in the shoulder joint, hand, biceps, thumb, and other tendon sites have been reported. The risk of tendon rupture is further increased in those over age 60, those receiving concomitant steroid therapy, and in kidney, heart, and lung transplant recipients. Reasons for tendon ruptures also include physical activity or exercise, kidney failure, and tendon problems in the past. These ruptures may occur during therapy or up to several months after discontinuation of drugs.