A 45-year-old patient has been taking Prednisone daily for 12 weeks to manage severe rheumatoid arthritis. The patient's condition has improved, and the healthcare provider decides to discontinue the medication. Which of the following statements best explains why gradually tapering down the Prednisone dose is necessary?

To decrease the cost of medication for the patient

To prevent the risk of acute adrenal insufficiency

To minimize the potential for drug interactions

To reduce the likelihood of rheumatoid arthritis flare-up

Answer and Explanation

The Correct Answer is B

A. To decrease the cost of medication for the patient: While cost may be a consideration in long-term therapy, it is not the primary reason for tapering corticosteroids. The tapering process is necessary to protect the patient’s physiological balance, not driven by cost concerns.
B. To prevent the risk of acute adrenal insufficiency: Long-term prednisone use suppresses the hypothalamic-pituitary-adrenal (HPA) axis. Abrupt discontinuation can lead to adrenal insufficiency, a potentially life-threatening condition characterized by hypotension, fatigue, and electrolyte imbalances. Gradual tapering allows the adrenal glands to resume natural cortisol production.
C. To minimize the potential for drug interactions: Tapering does not reduce drug interactions. Such risks are managed through medication reconciliation and monitoring, not by adjusting steroid taper schedules.
D. To reduce the likelihood of rheumatoid arthritis flare-up: While tapering may reduce flare risk, the primary concern is adrenal suppression. Flare prevention is managed with other disease-modifying agents rather than the tapering schedule alone.

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Correct Answer is D

Explanation

A. They inhibit the metabolism of alcohol in the liver: Benzodiazepines do not affect alcohol metabolism. Enzymes like alcohol dehydrogenase and aldehyde dehydrogenase are responsible for metabolizing alcohol, and benzodiazepines have no role in this process.
B. They block the reuptake of dopamine in the central nervous system: This mechanism is more characteristic of stimulant drugs like cocaine or certain antidepressants. Benzodiazepines act primarily on GABAergic pathways and do not target dopamine reuptake.
C. They have no potential for abuse or dependence: Benzodiazepines carry a well-documented risk of dependence and abuse, especially with long-term use or in individuals with a history of substance use disorders. Their use in alcohol withdrawal is carefully managed due to this risk.
D. They enhance the effects of GABA in the central nervous system: Benzodiazepines potentiate GABA, the brain’s primary inhibitory neurotransmitter, which helps to stabilize the CNS, reduce seizures, and manage agitation during alcohol withdrawal. This GABAergic action compensates for the decreased inhibitory tone seen in alcohol-dependent individuals during withdrawal.

A. "The risk of suicidal thoughts is highest during the first few weeks of treatment." B. "Antidepressants eliminate the risk of suicidal thoughts in all patients." C. "Suicidal thoughts are a common side effect experienced by most patients." D. "Suicidal thoughts only occur in patients with a history of suicide attempts."

Correct Answer is A

Explanation

A. "The risk of suicidal thoughts is highest during the first few weeks of treatment.": This is the most accurate statement. During the initial weeks of antidepressant therapy, especially in adolescents and young adults, the risk of suicidal ideation may increase as energy levels improve before mood stabilizes. Close monitoring during this period is critical.
B. "Antidepressants eliminate the risk of suicidal thoughts in all patients.": While antidepressants help many patients, they do not eliminate the risk of suicidal thoughts. Some individuals may continue to experience or even develop new suicidal ideation, particularly early in treatment.
C. "Suicidal thoughts are a common side effect experienced by most patients.": Suicidal ideation is a serious but not common side effect. It occurs in a subset of patients, particularly younger individuals, and must be monitored closely, but it is not experienced by the majority.
D. "Suicidal thoughts only occur in patients with a history of suicide attempts.": Suicidal ideation can develop in individuals without a previous history. Risk factors include age, underlying psychiatric conditions, and individual response to medication—not just past behavior.

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

A nurse is educating a patient who is starting a new antidepressant medication. Which statement by the nurse is most accurate regarding the risk of suicidal thoughts and behaviors associated with antidepressant use?

Correct Answer is A

Explanation

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