Which of the following drugs most likely caused the symptom reported by the patient?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Chlorpromazine. Chlorpromazine is a typical antipsychotic medication that acts by blocking dopamine receptors in the brain. One of the common side effects of chlorpromazine is extrapyramidal symptoms, such as muscle stiffness, tremors, and spasms. These symptoms are indicative of drug-induced movement disorders, known as extrapyramidal side effects (EPS). Hence, chlorpromazine is most likely to have caused the reported symptoms in the patient. Now, let's discuss why the other options are incorrect: A) Lithium: Lithium is primarily used to treat mood disorders like bipolar disorder. It does not typically cause extrapyramidal symptoms. B) Amitriptyline: Amitriptyline is a tricyclic antidepressant that does not commonly cause extrapyramidal symptoms. C) Fluoxetine: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used for treating depression and anxiety disorders. It is not associated with extrapyramidal symptoms like those seen in the patient. In an educational context, understanding the side effect profiles of different drug classes is crucial for safe medication administration and patient care. Nurses and healthcare professionals need to be able to recognize and attribute symptoms to specific medications to ensure timely interventions and prevent complications. This knowledge also helps in monitoring patients for adverse effects and adjusting treatment plans accordingly.

Correct Answer: A

Rationale: Amitriptyline is a tricyclic antidepressant that can interact with metoclopramide, leading to increased risk of side effects such as confusion, hallucinations, and irregular heart rhythm. This interaction is well-documented in medical literature and is a known pharmacodynamic interaction between the two drugs.

Correct Answer: C

Rationale: Hydrochlorothiazide is a diuretic that can lead to electrolyte imbalances and kidney issues, including anuria (inability to urinate). It is important to monitor patients on hydrochlorothiazide for signs of kidney dysfunction, especially in those with a history of hypertension and other comorbid conditions.

Correct Answer: B

Rationale: The most likely reason for the adverse effects reported by the patient is the decreased renal elimination of lithium caused by the antihypertensive treatment with hydrochlorothiazide. Thiazide diuretics like hydrochlorothiazide can decrease renal elimination of lithium, leading to an increase in lithium levels in the blood and potential toxicity. This interaction can result in symptoms such as lithium toxicity, which may present as mood swings and other adverse effects in a patient with bipolar disorder receiving lithium therapy. Therefore, choice B is the correct answer.

Correct Answer: A

Rationale: The appropriate drug for the patient at this time would be Amitriptyline. The patient, who was previously discharged on valproic acid for bipolar disorder, is now experiencing depressive symptoms after discontinuing therapy. Amitriptyline, a tricyclic antidepressant, would be suitable for treating the patient's depression. Tricyclic antidepressants like Amitriptyline are commonly used in the treatment of mood disorders, including bipolar depression. Therefore, choice A is the correct answer.