08-20-2007, 11:25 AM
14. A 38-year-old woman with systemic lupus erythematosus but no evidence of nephritis comes to the office because of a 3-week history of mood swings with crying spells, irritability and insomnia. She is especially upset because she has been yelling at her children "over small, everyday things." One month ago she started corticosteroid therapy. She is currently taking prednisone, 60 mg/day. Her other medications include an oral contraceptive (the same one for the past 6 years) and ibuprofen. She smokes one-half pack of cigarettes daily, drinks one to two beers 5 nights weekly and three cups of coffee each morning. Which of the following is the most appropriate intervention for her mood disturbance?
A
) Add amitriptyline at bedtime
B
) Discontinue the oral contraceptive
C
) Reduce the prednisone dosage
D
) Replace ibuprofen with acetaminophen
E
) Urge her to stop smoking and to reduce her alcohol and caffeine intake
A
) Add amitriptyline at bedtime
B
) Discontinue the oral contraceptive
C
) Reduce the prednisone dosage
D
) Replace ibuprofen with acetaminophen
E
) Urge her to stop smoking and to reduce her alcohol and caffeine intake