A 28-year-old man is seeking treatment for opioid use disorder with buprenorphine. He currently takes escitalopram for generalized anxiety disorder, prazosin for posttraumatic stress disorder-related nightmares, and alprazolam for panic attacks. Which of these medications should the psychiatric-mental health nurse practitioner consider discontinuing prior to induction of buprenorphine?

Choice A reason: Prazosin is an alpha-1 adrenergic antagonist commonly used to treat PTSD-related nightmares. It does not have significant CNS depressant effects and does not interact dangerously with buprenorphine. Therefore, it can be continued during induction. Choice B reason: Escitalopram is a selective serotonin reuptake inhibitor (SSRI) used for anxiety and depression. It does not pose a significant risk when combined with buprenorphine and is generally safe to continue during induction. Choice C reason: Alprazolam is a benzodiazepine with potent CNS depressant effects. When combined with buprenorphine, it increases the risk of respiratory depression, sedation, and overdose. Discontinuation or tapering is recommended prior to buprenorphine induction to reduce these risks. Choice D reason: This option implies that no medications need to be discontinued, which is incorrect. Alprazolam poses a significant safety concern and should be reconsidered before initiating buprenorphine.