JR is a 35 y/o female that presents to your clinic seeking help for her depressed mood. After evaluating her, you diagnose JR with major depressive disorder and prescribe her citalopram, an SSRI. Which counseling point is important to relay to JR? Select one:
Rise slowly from a laying or sitting position to avoid orthostatic hypotension and syncope
Titrate citalopram to maximum dose every 2 days to ensure optimal efficacy
Minor side effects such as nausea, somnolence and insomnia may occur but are typically transient and will go away in 1-2 weeks
Abrupt discontinuation will not lead to withdrawal due to its long half life
The Correct Answer is C
Selective serotonin reuptake inhibitors (SSRIs) are commonly used as first-line treatment for major depressive disorder because they improve mood by increasing serotonin availability in the brain. Patient education is important to improve adherence, especially during the first few weeks when side effects may occur before full therapeutic benefit is noticed. Many patients discontinue therapy early if they are not prepared for these temporary effects. Proper counseling helps improve treatment success and reduces unnecessary medication discontinuation.
Rationale:
A. Rising slowly from a lying or sitting position is more commonly emphasized with tricyclic antidepressants or antihypertensive medications that frequently cause orthostatic hypotension. Although SSRIs may occasionally cause dizziness, orthostatic hypotension is not a major expected adverse effect of Citalopram. This is not the primary counseling point that should be emphasized for routine SSRI initiation.
B. Citalopram should not be titrated rapidly every 2 days because antidepressants require gradual dose adjustments and time to assess response and tolerance. Rapid titration increases the risk of adverse effects such as serotonin syndrome, QT prolongation, and patient intolerance. Clinical improvement also takes several weeks, so aggressive dose escalation is inappropriate.
C. Minor side effects such as nausea, mild somnolence, headache, and insomnia are common during the early phase of SSRI treatment and are usually temporary. These symptoms often improve within 1 to 2 weeks as the body adjusts to the medication. Educating the patient about this helps reduce anxiety, improves adherence, and prevents premature discontinuation before therapeutic benefits are achieved.
D. Abrupt discontinuation of SSRIs can lead to discontinuation syndrome, which may include dizziness, irritability, flu-like symptoms, and sensory disturbances. Although some SSRIs with longer half-lives have lower risk, citalopram still requires gradual tapering rather than sudden cessation. Patients should always be instructed not to stop the medication suddenly without provider guidance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Benzodiazepines are central nervous system depressants used for the short-term management of anxiety disorders, panic disorders, and acute agitation. They work by enhancing the effect of gamma-aminobutyric acid (GABA), producing anxiolytic, sedative, and muscle-relaxant effects. Although effective, these medications carry a risk of tolerance, dependence, and withdrawal, especially with prolonged or high-dose use. The onset of action and duration of effect influence their abuse potential and likelihood of dependence.
Rationale:
A. Diazepam (Valium) has a long half-life and active metabolites, which results in a slower onset and more prolonged effect in the body. This pharmacokinetic profile generally leads to a lower risk of rapid dependence compared to shorter-acting benzodiazepines. While dependence is still possible, it tends to develop more gradually than with high-potency, short-acting agents.
B. Lorazepam (Ativan) is an intermediate-acting benzodiazepine commonly used for anxiety and acute agitation. It has a relatively faster onset than long-acting agents but still does not produce the same rapid reinforcement pattern associated with the highest-risk drugs. Dependence can occur, but it is generally less rapid compared to short-acting, high-potency agents like alprazolam.
C. Alprazolam (Xanax) is a short-acting, high-potency benzodiazepine with a rapid onset of action, which increases its reinforcing effects and potential for misuse. The quick relief of anxiety symptoms contributes to a higher risk of psychological and physical dependence. It is therefore the benzodiazepine most associated with rapid development of dependence among the options listed.
D. Clonazepam (Klonopin) is a long-acting benzodiazepine with a slower onset and longer duration of action. This results in more stable plasma levels and a lower likelihood of rapid reinforcement compared to short-acting agents. While dependence can still develop with prolonged use, it generally occurs more gradually than with alprazolam.
Correct Answer is C
Explanation
Acne treatment with topical retinoids such as Tretinoin commonly causes an initial “purging” phase where lesions may appear worse before improvement occurs. This happens because retinoids increase epidermal cell turnover and promote the expulsion of pre-existing microcomedones. Patients may become discouraged during this early phase and discontinue therapy prematurely. Proper counseling is essential to improve adherence and ensure therapeutic success.
Rationale:
A. Switching to an oral antibiotic is not indicated at this stage because the initial worsening seen with Tretinoin is not treatment failure but an expected early response. Oral antibiotics are reserved for moderate to severe inflammatory acne or cases that do not respond to topical therapy. Premature escalation exposes the patient to unnecessary systemic antibiotic risks.
B. Applying an oil-based lotion is not recommended because it may worsen acne by increasing follicular occlusion. While tretinoin can cause dryness and irritation, non-comedogenic moisturizers are preferred instead of oil-based products. The goal is to reduce irritation without exacerbating acne lesions.
C. Reassurance is appropriate because the early flare with Tretinoin is a well-known and temporary effect related to increased skin cell turnover. Continued use typically leads to significant improvement in comedonal and inflammatory acne after several weeks. Patient education helps prevent discontinuation during this expected adjustment period.
D. Changing to a different topical agent is unnecessary because this is not an allergic or severe adverse reaction. The initial worsening is an expected pharmacologic response rather than intolerance. Discontinuation or switching therapy too early may prevent the patient from achieving the full therapeutic benefit of tretinoin.
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