Two months ago, you saw Rupesh Shetty, a 34-year-old nurse, to whom you prescrib

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Two months ago, you saw Rupesh Shetty, a 34-year-old nurse, to whom you prescribed fluoxetine 20 mg daily and buspirone 5 mg po BID for anxiety.
Rupesh Intro Transcriipt
Rupesh: Hi, I’m Rupesh, my pronoun is he, and this is Duncan, my partner, pronouns also he. No, we aren’t married. Yes, we live together—we have a life commitment, and I’m asexual. Just wanted to get that out there upfront because I know you are going to ask.
Rupesh: [sighs deeply] Remember your first months as a new nurse? I just finished orientation and I’m struggling to keep up now. I’m… I’m having trouble clocking in on time because I have to be certain my hands are clean before I start my shift.
Duncan: He’s told me he sometimes washes his hands six times in a row. Maybe even seven or eight to be sure. He does this at home, too.
Rupesh: Yeah, he’s right. And after seeing a patient, I also have to clean the desk and computer with wipes just as many times, before I can finish the chart. My charge nurse says I’m overdoing the cleanliness a bit, but I just have to do it. And it’s not just cleanliness. At home, I’m the last to bed because I have to check the doors at night five to six times at night.
Duncan: Even if I’ve already locked up and he saw me do it.
Rupesh: Well, I feel like I have to have some control over my world. And, um, Duncan doesn’t know this, sometimes I get up after he falls asleep because I worry to the point that I will have to get up and go check one or two more times before I can go to sleep.”
Duncan: Actually, I did know about that, Rupesh. I’m also concerned because Rupesh will get focused on something and then not be able to shut his mind down. He perseverates and I cannot distract him for anything.”
Rupesh: I, uh, well, I think I’ve pretty much always had these kinds of symptoms, but they seem to be getting worse recently. I do feel kind of depressed, mainly because of the OCD symptoms that are causing so much trouble. I know you’re going to ask, so I can head this off! I don’t have any SI, HI, or auditory or visual hallucinations.
Today, Rupesh Shetty presents for a follow-up visit along with his mother Suma, and his life partner, Duncan. You note that his chart indicates that his PCP prescribed him alprazolam (Xanax) 1 mg po, three times a day as needed for anxiety.
Rupesh Follow Up Visit Transcriipt
Rupesh: This is my mom, Suma. She insisted on coming today. You know Indian Mums. She’s worried and wants to be sure I’m getting the best care, so I said sure, whatever, come along.
Suma: I am very worried about my Rup. He hasn’t been looking good.
Rupesh: I’ve tried to tell her that I’m doing ok as long as I take my medication, and I have been. Except, I haven’t been able to come in to work for the past three days because I ran out of my Xanax and I cannot even think about going to work without it. Tell them, Duncan, what it’s like.
Duncan: Yesterday, Rupesh couldn’t get through the day, so um, yeah, he took some of my mom’s Xanax yesterda—.
Suma: Did Rupesh tell you about his history of alcohol addiction? He’s been an alcoholic since he was in his early 20s. And did he tell you his dad also had problems with addiction? That’s not an addictive drug, is it?
Duncan: Addiction? Are you worried about addiction to this drug? Should we be worried? Rupesh are you addicted?
Duncan [agitated]: Did you know Rupesh is sometimes taking up to seven pills a day? At least that I know of. Is that overusing or addiction?
Rupesh almost starts crying: But, but, I can’t function without Xanax. Duncan, you know how hard nursing has been ever since I started 12-hour shifts. I love my job, but I just want to feel normal. And the Xanax makes me feel that way. Please…Xanax—it’s almost like a miracle drug and makes me so much more comfortable in uncomfortable situations, like at work and when dealing with people who can be very stressful. Without it my anxiety returns, like ten times worse. I used to feel euphoric and the pills relax my body. My doctor said the Xanax decreases abnormal brain activity, and has a calming effect on the body. Lately, yeah, I’ve taken probably more than seven pills a day. And I know it can sometimes cause mood changes, irritability, stomach problems and the worst part is when I take too much and become drowsy. I can never predict how Xanax will affect me but usually it just helps me function better.
Suma: Roop, that sounds terrible! I think you are addicted. Oh my goodness, what’s going to happen to your job? He’s a nurse!
After an extensive assessment of Rupesh, you conclude that he needs to be admitted inpatient because of his dependence on benzodiazepines. Rupesh is unwilling to go inpatient and asks you to just prescribe something to help him get off the alprazolam (Xanax).
explain to Rupesh, Duncan, and Suma the following:
Why is it so important for Rupesh to go inpatient? What are the risks of detoxing off alprazolam (Xanax) on his own?
How does alprazolam (Xanax) work? What makes the medication so addictive?
How do you answer Suma when she asks why anybody would prescribe alprazolam (Xanax) for Rupesh?
Are there any special considerations for Rupesh because he is a registered nurse?
What are the rules and regulations in your state of practice for impaired nurses?
What resources are in your community for addiction? Are there any resources specifically for benzodiazepines?
Remember to use language that is easy to understand because Duncan and Suma are not medical professionals. In your post, provide two peer-reviewed references that support your statements in the video and a link to online information for Rupesh about impaired nurses.

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