A 57-year old patient presents to your office complaining about poor appetite, anhedonia, persistent depressed mood and increased sleep latency. He reports chronic neuropathic pain in the feet unrelieved by analgesics. Which of the following medications may address the patient's symptoms of poor sleep, depressed mood, poor appetite and neuropathic pain?

Correct Answer: B

Rationale: The correct answer is B: Amitriptyline. This tricyclic antidepressant is commonly used to manage neuropathic pain, improve sleep quality, and treat depression. Amitriptyline can help alleviate the patient's symptoms of poor sleep, depressed mood, poor appetite, and neuropathic pain due to its dual mechanism of action that involves inhibiting the reuptake of serotonin and norepinephrine. A: Lorazepam is a benzodiazepine used for anxiety and insomnia, but it does not address neuropathic pain or depression symptoms. C: Trazodone is a sedating antidepressant often used for insomnia, but it may not be as effective for neuropathic pain as amitriptyline. D: Escitalopram is a selective serotonin reuptake inhibitor (SSRI) used for depression and anxiety, but it may not be as effective for neuropathic pain as amitriptyline.

Correct Answer: A

Rationale: The correct answer is A: Notify physician of allergic reaction. This is the priority action because hives can be a sign of an allergic reaction to a new medication, which can progress to a severe systemic reaction like anaphylaxis. Immediate physician notification is essential for prompt management, such as discontinuation of the medication and initiation of appropriate treatment. B: Idiosyncratic reactions are unpredictable and not related to allergies, so it is not the priority in this case. C: Teratogenicity refers to the potential harm to a fetus, which is not relevant when assessing hives in a patient. D: Tolerance is the body's decreased response to a medication over time, not a concern with hives in a patient on a new medication.

Correct Answer: C

Rationale: The correct answer is C: Fluconazole. This is because fluconazole is a systemic antifungal medication commonly used to treat systemic fungal infections. It has a broad spectrum of activity and is well-absorbed orally, making it suitable for systemic therapy. Amphotericin B (choice A) is used for severe systemic fungal infections due to its high toxicity. Nystatin (choice B) is primarily used topically for mucocutaneous candidiasis. Flucytosine (choice D) is used in combination therapy for systemic fungal infections, but fluconazole is typically preferred for initial therapy due to its lower toxicity profile and ease of administration.

Correct Answer: C

Rationale: The correct answer is C: Terbinafine. 1. Terbinafine is an antifungal medication commonly used to treat fungal infections like athlete's foot or nail fungus, which are often treated orally. 2. Acyclovir (A) is an antiviral drug used to treat herpes infections, not fungal infections. 3. Metronidazole (B) is an antibiotic used to treat bacterial infections, not fungal infections. 4. Vancomycin (D) is also an antibiotic used for bacterial infections, not fungal infections. Therefore, Terbinafine is the most appropriate choice for treating the patient's fungal infection orally.

Correct Answer: A

Rationale: The correct answer is A: Warfarin. Warfarin is commonly prescribed for stroke prevention in atrial fibrillation due to its ability to prevent blood clot formation by inhibiting clotting factors. Aspirin is less effective than warfarin for stroke prevention in atrial fibrillation. Metoprolol is a beta-blocker used for rate control in atrial fibrillation but does not directly prevent stroke. Heparin is a short-acting anticoagulant not typically used for long-term stroke prevention in atrial fibrillation.