A 49-year-old man presents to the PMHNP for his regular medication management appointment. He has schizophrenia and has been treated with thioridazine (Mellaril) for the past 15 years. The PMHNP decides to switch this patient to a different antipsychotic due to which serious long-term consequence of high-dose thioridazine?
Hyperprolactinemia
Priapism
Tardive dyskinesia
Retinal pigmentation
The Correct Answer is D
Choice A reason: Hyperprolactinemia is a known side effect of many antipsychotics, especially those that block dopamine D2 receptors in the tuberoinfundibular pathway. However, thioridazine is not particularly associated with this effect as a long-term consequence requiring discontinuation.
Choice B reason: Priapism is a rare but serious side effect of some psychotropic medications, particularly those with alpha-adrenergic blocking properties. Thioridazine has minimal association with priapism and it is not a common reason for long-term discontinuation.
Choice C reason: Tardive dyskinesia is a well-known risk of long-term use of typical antipsychotics, including thioridazine. However, while significant, it is not the most specific or unique reason for discontinuing thioridazine in this case. The question emphasizes a serious long-term consequence that is more distinctive to thioridazine.
Choice D reason: Retinal pigmentation and retinal toxicity are serious long-term consequences of high-dose thioridazine, especially when doses exceed 800 mg/day. This can lead to irreversible visual impairment, including nyctalopia, blurred vision, and pigmentary changes in the retina. This rare but severe adverse effect is a key reason clinicians discontinue thioridazine in favor of safer alternatives.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Dextromethorphan is a cough suppressant with NMDA antagonist properties. While it can cause dissociation or mood changes at high doses, it is not commonly associated with inducing depression.
Choice B reason: Diphenhydramine is an antihistamine that may cause sedation or cognitive dulling but is not typically linked to depressive symptoms.
Choice C reason: Isotretinoin, used for severe acne, has been associated with psychiatric side effects including depression and suicidal ideation, particularly in adolescents. Its neuropsychiatric risk profile is well-documented and warrants close monitoring.
Choice D reason: Pseudoephedrine is a decongestant that may cause agitation or insomnia but is not known to induce depression.
Correct Answer is C
Explanation
Choice A reason: Escitalopram has a relatively short half-life and typically requires a 2-week washout period before initiating an MAOI to avoid serotonin syndrome.
Choice B reason: Sertraline also has a shorter half-life and does not require a 5-week washout. A 2-week period is generally sufficient.
Choice C reason: Fluoxetine has the longest half-life among SSRIs, with active metabolites that persist in the body for weeks. Due to this extended duration, a 5-week washout period is recommended before starting an MAOI to prevent serotonin toxicity.
Choice D reason: Paroxetine has a short half-life and would not necessitate a 5-week washout. A 2-week interval is typically adequate.
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