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 D
Explanation
Choice A reason: Melatonin is a hormone that regulates the sleep-wake cycle and induces drowsiness. While it affects consciousness and is technically psychoactive, it is not classified as an herbal supplement but rather a hormone. Its psychoactivity is mild and primarily limited to sleep regulation.
Choice B reason: Tryptophan is an amino acid precursor to serotonin, which influences mood and sleep. It has psychoactive properties due to its role in serotonin synthesis, but it is not typically categorized as a standalone psychoactive herbal supplement.
Choice C reason: SAM-e (S-Adenosyl-L-methionine) is a compound involved in neurotransmitter synthesis and is used for mood disorders. It alters mental states and is considered psychoactive, but it is a synthesized supplement rather than a traditional herbal product.
Choice D reason: Valerian is a well-known herbal supplement with sedative properties. It acts on GABA receptors in the brain, promoting relaxation and drowsiness. Among the choices, it is the most classically recognized psychoactive herbal product due to its direct central nervous system effects.
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.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.