A 36-year-old female client presents to the psychiatric-mental health nurse practitioner. She has been stable for 1 year but says her buprenorphine regimen has not been working since she started a new medication prescribed by her primary care provider. Which medication most likely contributed to the decrease in buprenorphine efficacy?
Carbamazepine (Tegretol)
Amitriptyline (Elavil)
Fluoxetine (Prozac)
Erythromycin
The Correct Answer is A
Choice A reason: Carbamazepine is a known inducer of the cytochrome P450 3A4 enzyme, which metabolizes buprenorphine. Its induction leads to increased metabolism and reduced plasma levels of buprenorphine, thereby decreasing its efficacy. This interaction can result in withdrawal symptoms or reduced control of opioid use disorder.
Choice B reason: Amitriptyline is a tricyclic antidepressant that does not significantly affect buprenorphine metabolism. While it may have sedative effects or interact with other CNS depressants, it is not known to reduce buprenorphine efficacy.
Choice C reason: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) and a CYP2D6 inhibitor. It does not significantly impact buprenorphine levels or efficacy. Its interaction profile is more relevant to serotonergic drugs than opioids.
Choice D reason: Erythromycin is a macrolide antibiotic and a CYP3A4 inhibitor. It can increase buprenorphine levels rather than decrease them. Therefore, it would not contribute to reduced efficacy but might increase side effects.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Any financial incentive from a pharmaceutical company, regardless of amount, constitutes a potential conflict of interest. It may influence prescribing behavior or create bias, even subconsciously. Ethical guidelines emphasize transparency and avoidance of even minor inducements that could compromise clinical judgment.
Choice B reason: While this reflects a possible psychological consequence of accepting the gift, it is speculative. The core issue is the presence of a financial incentive from an industry source, which is inherently a conflict of interest.
Choice C reason: The equivalence to a meal cost does not negate the ethical concern. The form of the incentive is less important than its source and potential influence. Ethical standards apply regardless of the delivery method.
Choice D reason: Lack of reporting does not eliminate the conflict. Ethical practice requires recognition and management of potential conflicts, not just disclosure.
Correct Answer is C
Explanation
Choice A reason: The t-test is used to compare the means of two groups. It is not suitable for analyzing differences among three or more groups, as it increases the risk of Type I error when used repeatedly.
Choice B reason: Pearson’s r correlation measures the strength and direction of a linear relationship between two variables. It does not test group differences.
Choice C reason: Analysis of variance (ANOVA) is the appropriate statistical test for comparing means across three or more groups. It determines whether there are statistically significant differences among group means and controls for error rates.
Choice D reason: Probability is a general concept in statistics and not a specific inferential test. It underlies statistical reasoning but does not directly test group differences.
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