MED 143 ANTIDEPRESSANT AGENTS – CHAPTER 21 QUESTIONS VERIFIED ANSWERS 2023

MED 143 ANTIDEPRESSANT AGENTS – CHAPTER 21 QUESTIONS VERIFIED ANSWERS 2023. A nurse is working with a 9-year-old child who exhibits signs and symptoms of obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may be prescribed for the child? A) Phenelzine (Nardil) B) Amitriptyline (Elavil) C) Fluvoxamine (Prozac) D) Isocarboxazid (Marplan) Ans: C Feedback: Fluvoxamine is a selective serotonin reuptake inhibitor that has established pediatric dosage guidelines for the treatment of obsessive-compulsive disorder. Isocarboxazid and phenelzine are monoamine oxidase inhibitors and should be avoided in pediatric use because of the potential drug–food interactions and other serious adverse effects. Amitriptyline is also a tricyclic antidepressant not recommended for pediatric use. Page 1 4.A patient explains to a nurse that he had been taking amitriptyline (Elavil) for depression and that his physician changed his medication to clomipramine (Anafranil). The patient is confused and does not understand why his medication was changed. The nurse's best response to the patient would be what? A) “These drugs are similar but some patients respond better to one drug than another.” B) “Did you take the amitriptyline like you should have?” C) “Maybe the old medicine wasn't working anymore.” D) “Clomipramine is newer and will be much better for you.” Ans: A Feedback: Because all tricyclic antidepressants (TCAs) are similarly effective, the choice of which TCA depends on individual response to the drug and tolerance of adverse effects. A patient who does not respond to one TCA may respond to another drug from this class. In addition, the nurse might inform the physician of the patient's question so the physician can explain his or her rationale for changing medications. By asking the patient if he took the medication as prescribed, the nurse is insinuating that he may not have and could damage the trusting nurse–patient relationship. The nurse has no basis for commenting that the medication might not be working or that another drug would work better. 5.A patient comes to the mental health clinic for a regular appointment. The patient tells the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past 3 weeks and that he has lost 3 pounds during that time due to a loss of appetite. What action should the nurse take? A) Teaching the patient about healthy eating to maintain weight B) Congratulating the patient on his weight loss and commenting how well he looks C) Encouraging the patient to increase fluid intake to avoid further weight loss D) Reassuring the patient that a decrease in weight is a common adverse effect with this medication Ans: D Feedback: Adverse effects of fluoxetine include anorexia and weight loss. Although teaching about healthy eating is a good idea, it is more important to teach the patient how to take the medication in a way that will reduce adverse effects as well as how to optimize healthy calories to maintain weight. The patient should increase caloric intake, not just fluid intake. The patient should continue the medication to see whether therapeutic effects are obtained and adjust nutritional intake if necessary. More information about the patient's baseline weight is needed before congratulating the patient because a patient who is already too thin would not appreciate the nurse's comment. 6.A patient diagnosed with type 1 diabetes mellitus is receiving insulin. The physician has prescribed a monoamine oxidase inhibitor (MAOI) to treat this patient's depression. What interaction will the nurse assess for with this drug combination?