20. 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?
Answer: D
Furosemide must be stopped immediately.
Furosemide, a loop diuretic, is known to potentially cause ototoxicity, which can lead to symptoms such as tinnitus, including hissing, ringing, and buzzing in the ears. Given the patient's reports of these symptoms, discontinuing Furosemide is necessary to prevent further auditory damage.
A) Fosinopril
Fosinopril is an ACE inhibitor primarily used for hypertension and heart failure. It does not have a known association with causing tinnitus or auditory disturbances, making it an unlikely cause of the patient's symptoms.
B) Finasteride
Finasteride is used to treat conditions like benign prostatic hyperplasia and male pattern baldness. While it has side effects, tinnitus is not commonly recognized as one of them, so it is not the medication that needs to be stopped immediately.
C) Famotidine
Famotidine is an H2 receptor antagonist used to reduce stomach acid. There is no significant evidence linking Famotidine to tinnitus or ear ringing, thus it does not pose a risk in this context and should not be stopped.
D) Furosemide
Furosemide is a loop diuretic that can lead to ototoxicity, which manifests as symptoms like tinnitus. Given the patient's complaints of hissing, ringing, and buzzing in the ears, stopping Furosemide is crucial to prevent further auditory complications.
Conclusion
Furosemide is the only medication listed that has a direct association with the development of tinnitus, making it imperative to stop it immediately in this scenario. The other options, Fosinopril, Finasteride, and Famotidine, lack such a connection and therefore do not warrant discontinuation based on the patient's symptoms.