NBMEq - casanova

[ArchivalUser]

a 38 year old w with lupus but no evidence of nephritis comes to the office with hx of mood swinggs 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,0 mg/day.Her other medications include an oral contraceptive(the same one for the past 6 years)and IBUprofen.She smokes 1/2 pack of cigarrettes daily,drink 1 to 2 beers 5 nights weekly and 3 cups of cofee each morning.Which of the following is the most appriopriate intervention for her mood disturbance?-
a-add amitriptyline at bedtime
b-discontinue the oral contraceptive
c-reduce the prednison dosage
d-replace ibuprofen with acetaminophen
e-urge her to stop smoking and to reduce her alcoho and caffeine intake

[ArchivalUser]

I don't know B and E give me a lot of problem
But since her mood disturbances start at the same time when she start the corticosteroid.
I'll go for C and i think it will be time also to taper the dosage

[ArchivalUser]

answer

[ArchivalUser]

Yes c is the answer.This is steroid induced irritability.Some times reducing dose will help.Mood stabilizers also very helpful in this case but answer choice is C.

[ArchivalUser]

I too feel its c....morning caffeiene shouldnt cause insomnia

[ArchivalUser]

-reduce the prednison dosage