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Depression measurement-based care — USMLE Step 3 MCQ

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HardPsychiatry (outpatient management)Depression measurement-based careUSMLE Step 3

A 15-year-old who can become pregnant has obesity despite intensive lifestyle therapy. After shared decision-making, phentermine/topiramate extended release is selected and reliable contraception is planned. Which additional safety plan is required by the prescribing information?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Obtain a pregnancy test before treatment and monthly thereafter

The best answer is “Obtain a pregnancy test before treatment and monthly thereafter”. Topiramate exposure in early pregnancy can cause oral clefts; the REMS-supported label therefore pairs effective contraception with baseline and monthly pregnancy testing. Qsymia is indicated for obesity in patients age 12 years or older; for patients who can become pregnant, obtain a negative pregnancy test before treatment and monthly during therapy and advise effective contraception. The alternatives use a different threshold, timing, population, or intervention and therefore do not match the clinical facts presented.

Reference: DailyMed: QSYMIA Prescribing Information: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=40dd5602-53da-45ac-bb4b-15789aba40f9&type=display