A 16-year-old pregnant adolescent has been treated for acute cystitis. To determine the effectiveness of therapy with nitrofurantoin (Macrobid), the nurse practitioner instructs the adolescent to return for a urine culture:

Rationale:
A. St. John’s wort is not recommended during pregnancy due to limited safety data and potential drug interactions.
B. SNRIs may be considered in adults but have less safety data in pregnancy compared with SSRIs.
C. Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacologic therapy for depression during pregnancy when nonpharmacologic measures are insufficient. SSRIs like sertraline or fluoxetine have the most safety data for use in pregnant adolescents.
D. Tricyclic antidepressants (TCAs) are generally reserved for cases unresponsive to SSRIs due to more adverse effects and risk of cardiotoxicity.

Rationale:
A. Oxybutynin (Ditropan XL) is used primarily for bladder overactivity and may be considered earlier than third-line therapy depending on the patient’s symptoms.
B. Desmopressin acetate (DDAVP) is usually first-line pharmacologic therapy for primary nocturnal enuresis, particularly when fluid restriction and behavioral strategies have failed.
C. Tolterodine (Detrol) is another anticholinergic used for overactive bladder but is generally not considered third-line for uncomplicated enuresis.
D. Imipramine (Tofranil), a tricyclic antidepressant, is considered third-line therapy for enuresis due to its potential for significant side effects, including cardiac toxicity in overdose. It is reserved for patients who do not respond to behavioral strategies and first-line medications.