The nurse is teaching parents of a 14-year-old patient diagnosed with anorexia nervosa about prescribed medications. Which carries a black box warning?

Choice A reason: Phenelzine is a monoamine oxidase inhibitor (MAOI) used for treatment-resistant depression. While it carries significant dietary and drug interaction risks, it does not carry a black box warning specifically related to suicidality in adolescents. Its use in anorexia nervosa is rare due to its side effect profile and dietary restrictions. Choice B reason: Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), carries a black box warning for increased risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders. This warning is mandated by the FDA and is especially relevant when treating adolescents with anorexia nervosa, who may have comorbid depression or anxiety. Choice C reason: Amitriptyline is a tricyclic antidepressant that may be used off-label for chronic pain or sleep disturbances. While it has anticholinergic side effects and cardiac risks, especially in overdose, it does not carry the same black box warning for suicidality in adolescents as SSRIs like fluoxetine. Choice D reason: Topiramate is an anticonvulsant sometimes used off-label for binge eating or weight loss. It carries warnings for cognitive impairment and metabolic acidosis but does not have a black box warning for suicidality in adolescents.