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 C
Explanation
Choice A rationale: While generalized anxiety disorder is a significant mental health concern, it generally carries a lower immediate risk for suicide compared to specific populations facing acute social rejection, identity crises, or systemic lack of support.
Choice B rationale: A recent breakup is a stressful life event that can trigger emotional distress. However, the absence of depression or other co-occurring mental health symptoms statistically lowers this individual's risk compared to other high-risk groups.
Choice C rationale: LGBTQ+ adolescents, particularly those who have recently come out, face a significantly higher risk of suicide due to potential lack of family acceptance, bullying, and social stigma. This population experiences much higher rates of suicidal ideation.
Choice D rationale: A diagnosis of depression is a major risk factor for suicide. However, statistical data consistently shows that the combination of adolescent development and the stressors associated with identifying as a sexual minority creates an even higher risk profile.
Correct Answer is C
Explanation
Choice A reason: The power of nursing boards is unrelated to the classification of a case as civil or criminal. Boards regulate licensure and professional conduct but do not determine legal case types.
Choice B reason: Hiring a good attorney may influence the outcome of a case but does not determine whether it is civil or criminal. The nature of the act and intent are the key factors.
Choice C reason: Civil cases typically involve negligence or malpractice where harm results from a lack of due care, not criminal intent. Since the NP did not act with malice or intent to harm, the case is classified as civil, focusing on compensation rather than punishment.
Choice D reason: Criminal charges are filed by the state, not the patient. A patient cannot “drop” criminal charges. The classification depends on the nature of the act, not the victim’s decision.
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