A 40-year-old man has been taking fluoxetine (Prozac) for seasonal depression for the past 3 months, as prescribed by his psychiatric-mental health nurse practitioner. He believes his symptoms are well controlled. The patient's primary care provider recently prescribed atorvastatin (Lipitor) for hypercholesterolemia. Today, he complains of muscle and joint pain. The PMHNP suspects possible rhabdomyolysis.
Which answer choice describes the reason for this?
Rhabdomyolysis is a side effect of atorvastatin
Rhabdomyolysis is a side effect of fluoxetine
Lipitor is a CYP450 3A4 substrate and fluoxetine is a CYP450 3A4 inducer
Lipitor is a CYP450 3A4 substrate and fluoxetine is a CYP450 3A4 inhibitor
The Correct Answer is D
Choice A reason: While rhabdomyolysis is a known rare adverse effect of atorvastatin, the risk increases significantly when atorvastatin interacts with other drugs that inhibit its metabolism. This answer is partially correct but does not explain the mechanism.
Choice B reason: Fluoxetine is not commonly associated with rhabdomyolysis as a direct side effect. Its role in this case is more likely due to drug-drug interaction rather than intrinsic toxicity.
Choice C reason: Fluoxetine is not a CYP450 3A4 inducer. This choice is incorrect because it misrepresents fluoxetine’s pharmacologic profile.
Choice D reason: Fluoxetine is a known inhibitor of CYP450 3A4. Atorvastatin is metabolized by this enzyme. Inhibition of CYP3A4 by fluoxetine can lead to increased plasma levels of atorvastatin, raising the risk of statin-induced rhabdomyolysis due to impaired clearance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: The role of a group leader is often more complex than that of an individual therapist due to the need to manage group dynamics, multiple personalities, and interpersonal conflicts.
Choice B reason: Training requirements vary by setting and specialty. There is no consistent evidence that group leaders possess more training than individual therapists.
Choice C reason: While loss of control is a risk in any therapeutic setting, this is not a benefit. It represents a potential hazard, not an advantage.
Choice D reason: Group therapy offers unique interpersonal learning opportunities. Members not only receive support but also learn to provide it, enhancing empathy, communication, and relational skills. This mutual exchange fosters growth and insight that individual therapy may not replicate.
Correct Answer is B
Explanation
Choice A reason: Leukopenia and decreased creatine phosphokinase are not consistent with neuroleptic malignant syndrome (NMS). NMS typically presents with elevated muscle enzymes due to muscle breakdown.
Choice B reason: Leukocytosis and elevated creatine phosphokinase (CPK) are hallmark laboratory findings in NMS. The elevated CPK reflects rhabdomyolysis from severe muscle rigidity, and leukocytosis indicates systemic inflammation.
Choice C reason: Thrombocytosis may occur in various inflammatory conditions but is not a defining feature of NMS. The absence of elevated CPK makes this option less diagnostic.
Choice D reason: Leukopenia and thrombocytopenia are more indicative of bone marrow suppression or hematologic disorders, not NMS.
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