A nurse is reviewing the medication history of a client who has generalized anxiety disorder. The client reports taking alprazolam three times a day for the past year. The nurse should identify that abrupt discontinuation of this medication can result in which of the following adverse effects?

“I will take this medication in the morning to avoid insomnia.” Fluoxetine is a type of antidepressant that belongs to the class of selective serotonin reuptake inhibitors (SSRIs). It works by increasing the level of serotonin, a neurotransmitter that regulates mood, sleep, and appetite, in the brain.Fluoxetine can cause insomnia as a side effect, so it is recommended to take it in the morning.

Some of the other choices are wrong because:

• Choice B. “I will stop taking this medication if I have sexual dysfunction.” Fluoxetine can also cause sexual dysfunction as a side effect, such as reduced libido, difficulty with orgasm, or erectile dysfunction.

However, stopping the medication abruptly can cause withdrawal symptoms, such as nausea, headache, dizziness, and anxiety.Therefore, it is important to consult with the doctor before stopping or changing the dose of fluoxetine.

• Choice C. “I will increase my intake of cheese and red wine while taking this medication.” Fluoxetine can interact with foods that contain high levels of tyramine, a compound that can affect blood pressure and cause headaches.

Tyramine is found in aged cheeses, red wine, beer, cured meats, soy sauce, and other fermented or pickled foods.Consuming these foods while taking fluoxetine can increase the risk of a hypertensive crisis, which is a medical emergency that requires immediate attention.

• Choice D. “I will taper off this medication slowly when I feel better.” Fluoxetine should not be stopped or tapered off without the doctor’s guidance.

Although fluoxetine has a long half-life and is less likely to cause withdrawal symptoms than other SSRIs, some people may still experience them if they stop taking it too quickly.Withdrawal symptoms can include mood changes, irritability, agitation, confusion, insomnia, fatigue, flu-like symptoms, and electric shock sensations.

The doctor will advise on how to gradually reduce the dose of fluoxetine over several weeks or months to avoid these effects.

Seizures.

Alprazolam is a benzodiazepine that acts on the GABA receptors in the brain to reduce anxiety.

Abrupt discontinuation of alprazolam can cause withdrawal symptoms, such as seizures, tremors, insomnia, and anxiety.

To prevent this, alprazolam should be tapered off gradually under medical supervision.

Choice B is wrong because alprazolam does not cause hypotension when discontinued.

Hypotension is a possible side effect of alprazolam when taken, especially in high doses or with alcohol.

Choice C is wrong because alprazolam does not cause bradycardia when discontinued.

Bradycardia is a possible side effect of alprazolam when taken, especially in older adults or with other medications that slow down the heart rate.

Choice D is wrong because alprazolam does not cause constipation when discontinued.

Constipation is a possible side effect of alprazolam when taken, especially in older adults or with other medications that affect the gastrointestinal motility.