A patient comes to the clinic with reports of hissing, ringing, and buzzing in bilateral ears being loud at night. Which medication must be stopped immediately?

Rationale

Furosemide must be stopped immediately.

Furosemide is a loop diuretic that can cause ototoxicity, leading to symptoms such as tinnitus, which includes hissing, ringing, and buzzing sensations in the ears. In patients experiencing these symptoms, it is crucial to discontinue the medication to prevent further auditory damage.

A (Fosinopril) YOUR ANSWER

Fosinopril is an ACE inhibitor primarily used to manage hypertension and heart failure. While it has some associated side effects, it is not known to cause tinnitus or auditory disturbances. Therefore, stopping this medication would not address the patient's symptoms.

B (Finasteride) YOUR ANSWER

Finasteride is a medication used primarily for benign prostatic hyperplasia and male pattern baldness. It is not associated with tinnitus or any significant auditory side effects. Therefore, discontinuing finasteride would not be relevant to the patient's condition.

C (Famotidine) YOUR ANSWER

Famotidine is an H2 antagonist used to treat gastroesophageal reflux disease and peptic ulcers. It is generally well-tolerated and does not have a known link to causing tinnitus or hearing issues. Thus, stopping this medication would not resolve the patient's auditory symptoms.

D (Furosemide) CORRECT

Furosemide, as mentioned, can lead to ototoxicity, especially at higher doses or in patients with renal impairment. The patient's reports of hissing, ringing, and buzzing in both ears indicate a clear adverse effect from this medication, necessitating its immediate discontinuation to prevent potential permanent hearing loss.

Conclusion

In this case, the patient's symptoms of tinnitus are directly attributable to furosemide, which has a known risk of causing ototoxicity. While the other medications listed do not cause similar auditory symptoms, furosemide should be stopped to mitigate further risk to the patient's hearing. Recognizing and addressing drug-induced side effects is essential for effective patient management.

A patient comes to the clinic with reports of hissing, ringing, and buzzing in bilateral ears being loud at night. Which medication must be stopped immediately?

Furosemide must be stopped immediately.

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