A patient talks very less, prefers to be alone, his condition was treated with fluoxetine (Prozac). The nurse educates the patient and family members about proper bowel regimen and high fiber diet, and to increase fluid intake as medicines may cause constipation. Which medicine is the patient on?

1. A

   Antipsychotic

2. B

   Antidepressant

3. C

   Mood stabilizers

4. D

   Anti convulsive

Appeared in: NHM MP Staff Nurse-2022

Explanation

• Fluoxetine (Prozac) is classified as a Selective Serotonin Reuptake Inhibitor (SSRI), which is a major class of antidepressant medications.
• The patient's symptoms of social withdrawal (talking less, preferring to be alone) are classic signs of depression, a primary indication for prescribing fluoxetine.
• Constipation is a known side effect of many antidepressants. The nurse's intervention to educate the patient on a high-fiber diet and increased fluid intake directly addresses this common adverse effect.

Why Other Options Were Wrong

• Option A: Antipsychotic medications are primarily used to treat psychosis, such as in schizophrenia or severe mania, which involves symptoms like hallucinations or delusions, not the social withdrawal described.
• Option C: Mood stabilizers are the first-line treatment for bipolar disorder, which is characterized by extreme mood swings between mania (highs) and depression (lows). The patient's symptoms only describe a depressive state.
• Option D: Anti-convulsive (or antiepileptic) drugs are primarily used to prevent and control seizures. While some have secondary uses as mood stabilizers, they are not the primary class for treating depression.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Classification and side effects of psychotropic medications to guide bedside assessment, documentation, and the next nursing action.
• A key nursing responsibility is patient education on medication side effects. For antidepressants like fluoxetine, teaching about managing constipation, delayed therapeutic onset (2-4 weeks), and not stopping the drug abruptly is crucial for adherence and safety.
• Nurses must perform a suicide risk assessment, especially in the first few weeks of antidepressant therapy. As the medication begins to work, the patient's energy may return before their mood lifts, creating a high-risk period for self-harm.
• What if? If the patient's history also included periods of elevated mood, hyperactivity, and racing thoughts, the diagnosis might be bipolar disorder. In that case, prescribing an antidepressant alone could trigger a manic episode, and a mood stabilizer would be the more appropriate class of medication.

How to Approach the Question

• First, identify the key piece of information in the question: the specific drug name, 'fluoxetine (Prozac)'.
• Recall or determine the pharmacological class of fluoxetine. It is one of the most well-known SSRIs, which are antidepressants.
• Use the other information in the scenario as confirming evidence. The patient's symptoms (social withdrawal) are consistent with depression, and the side effect (constipation) is a known adverse effect of antidepressants.
• Based on the drug classification, select the corresponding option. 'Antidepressant' is the direct and correct answer.
• Briefly consider the other options to confirm they are incorrect. Antipsychotics, mood stabilizers, and anti-convulsants have different primary indications (psychosis, bipolar disorder, seizures, respectively).

Concept Tested & Keywords

• Concept Tested: Classification and side effects of psychotropic medications
• Stem keywords: fluoxetine (Prozac), constipation, high fiber diet, antidepressant
• Lead-in keywords: Which medicine
• Clinical cues: Medication: Fluoxetine (Prozac) - points to the antidepressant class.
• Clinical cues: Side effect: Constipation - a common side effect of psychotropic medications, including SSRIs.

Question ID

Q_w17hgP6o5yIzskuzY9MI

Copy ID

Reference Book

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 2 (pp 290-564 of 579) p. 248-250

E6 Medicine Harrison 22e Part 2 p. 1563-1565

E6 Medicine Harrison 22e Part 1 p. 126-128