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 C
Explanation
Choice A reason: Self-absorption is more characteristic of adolescent egocentrism, such as the imaginary audience or personal fable, but it is not the defining cognitive feature of the formal operational stage.
Choice B reason: Circular reactions are part of Piaget’s sensorimotor stage, where infants repeat actions to explore their environment. This is not relevant to formal operational thinking.
Choice C reason: Hypothetico-deductive thinking is the hallmark of the formal operational stage. It involves the ability to think abstractly, formulate hypotheses, and systematically test them. This stage typically begins around age 11 and enables scientific reasoning and complex problem-solving.
Choice D reason: Syllogistic reasoning is a component of logical thinking but is not the defining feature of the formal operational stage. It may emerge earlier and does not encompass the full scope of abstract reasoning seen in this stage.
Correct Answer is B
Explanation
Choice A reason: Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that can be used for depression and pain. However, it has moderate CYP2D6 inhibition, which may interfere with tamoxifen metabolism and reduce its efficacy.
Choice B reason: Venlafaxine is an SNRI with minimal CYP2D6 inhibition. It is effective for depression and also helps alleviate hot flashes, making it the most appropriate choice for this patient.
Choice C reason: Bupropion is a norepinephrine-dopamine reuptake inhibitor and a strong CYP2D6 inhibitor. It can significantly reduce the conversion of tamoxifen to its active metabolite, endoxifen, thereby compromising its therapeutic effect.
Choice D reason: Fluoxetine is a potent CYP2D6 inhibitor and should be avoided in patients taking tamoxifen due to the risk of reducing its efficacy in preventing breast cancer recurrence.
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