Which patient should not receive mitotane as ordered?

Mitotane is primarily used in the treatment of adrenocortical carcinoma, a type of cancer affecting the adrenal glands. It acts by inhibiting adrenal cortex function and is often employed in patients undergoing treatment for this condition. While it can be effective, its use requires careful consideration of the patient's overall condition.

In the context of the question, a patient experiencing shock should not receive mitotane. Shock indicates a critical state where blood flow to organs is severely compromised, leading to potential organ dysfunction and failure. Administering mitotane could exacerbate existing hemodynamic instability and further worsen the patient's clinical state, as the drug suppresses cortisol production. Cortisol is vital for maintaining cardiovascular stability during stress situations, such as shock.

Conversely, a patient feeling dizzy may still be stable and require assessment to determine the cause of dizziness, and a patient diagnosed with adrenocarcinoma is the primary candidate for mitotane treatment. Additionally, a patient with a heart rate of 100 beats per minute might be experiencing tachycardia, but unless there are other significant signs of instability, they may still be appropriate for treatment with mitotane.