A patient is taking tranylcypromine sulfate (Parnate) for depression. What advice should the nurse include in the teaching plan for this medication?
Warn the patient about severe hypotension.
Instruct the patient to avoid beer and cheddar cheese.
Encourage the patient to take ginseng and ephedra.
Encourage the patient to eat fruit such as bananas.
The Correct Answer is B
Monoamine oxidase inhibitors (MAOIs) such as tranylcypromine (Parnate) are prescribed for patients with depression who do not respond well to other antidepressants. While effective, they require careful monitoring because of their high potential for dangerous food and drug interactions. MAOIs such as tranylcypromine (Parnate) can cause hypertensive crisis when taken with foods high in tyramine. Patient education must emphasize strict dietary restrictions to prevent life-threatening complications.
B. Instruct the patient to avoid beer and cheddar cheese.
Beer, cheddar cheese, and other tyramine-rich foods can precipitate a sudden and dangerous rise in blood pressure. Patients must avoid these foods completely while on MAOIs.
A. Warn the patient about severe hypotension.
MAOIs are more likely to cause orthostatic hypotension rather than severe hypotension, but the greater safety concern is hypertensive crisis due to food-drug interactions.
C. Encourage the patient to take ginseng and ephedra.
Both ginseng and ephedra can dangerously increase blood pressure when combined with MAOIs and should be avoided.
D. Encourage the patient to eat fruit such as bananas.
Bananas contain tyramine (especially overripe ones) and should be avoided to prevent a hypertensive crisis.
Take-Home Points:
- MAOIs require strict dietary restrictions to prevent hypertensive crisis.
- Tyramine-rich foods such as aged cheese, beer, and cured meats must be avoided.
- Nurses must educate patients on drug–food and drug–herb interactions with MAOIs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Selective serotonin reuptake inhibitors (SSRIs) are a first-line treatment for depression and anxiety disorders. They act by inhibiting the reuptake of serotonin, thereby increasing its availability in the synaptic cleft and enhancing mood regulation. Knowing which drugs belong to this class is essential for safe nursing practice.
A. paroxetine (Paxil)
– Paroxetine is an SSRI, along with fluoxetine, sertraline, citalopram, and escitalopram. These drugs are widely prescribed because they are effective, well tolerated, and have fewer cardiovascular and anticholinergic effects compared to older antidepressants. Patients should be counseled that benefits may take several weeks to appear and to watch for adverse effects such as sexual dysfunction and insomnia.
B. amitriptyline (Elavil)
– Amitriptyline is a tricyclic antidepressant (TCA). TCAs work by blocking the reuptake of both serotonin and norepinephrine but are less selective than SSRIs. They carry risks of sedation, orthostatic hypotension, and anticholinergic effects (dry mouth, urinary retention, constipation).
C. divalproex sodium (Depakote)
– Divalproex is a mood stabilizer and anticonvulsant, commonly prescribed for bipolar disorder and seizure disorders. It does not act on serotonin reuptake and therefore is not classified as an SSRI.
D. bupropion HCl (Wellbutrin)
– Bupropion is an atypical antidepressant that inhibits the reuptake of dopamine and norepinephrine. It is useful in depression and smoking cessation but is not serotonergic and carries a risk of seizures at higher doses.
Take-Home Points:
- SSRIs: fluoxetine, paroxetine, sertraline, citalopram, escitalopram.
- SSRIs are first-line for depression/anxiety due to better tolerability.
- Always assess for serotonin syndrome and suicidal ideation when initiating therapy.
Correct Answer is D
Explanation
Bipolar affective disorder is commonly managed with mood stabilizers. While lithium remains a first-line therapy, not all patients tolerate it due to side effects, drug interactions, or contraindications. In such cases, anticonvulsants such as divalproex (Depakote) are used as alternatives or adjuncts for mood stabilization.
D. divalproex (Depakote)
– Divalproex is an anticonvulsant that is also FDA-approved for bipolar disorder. It is especially effective in managing acute mania, mixed episodes, and rapid cycling. It is considered a reliable alternative for patients who cannot tolerate lithium due to renal impairment, toxicity risk, or lack of response.
A. thiopental
– Thiopental is a barbiturate used for induction of anesthesia and rapid sedation. It does not have a role in mood stabilization or long-term psychiatric management.
B. gingko biloba
– Ginkgo is an herbal supplement sometimes used to improve memory and circulation. It is not approved or effective for treating bipolar disorder and could potentially interact with psychiatric medications.
C. fluvoxamine (Luvox)
– Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) used for depression and obsessive-compulsive disorder. While it can treat depressive symptoms, SSRIs alone can trigger manic episodes in bipolar patients, making them inappropriate as primary treatment.
Take-Home Points:
- Lithium is first-line for bipolar disorder, but divalproex is a widely used alternative.
- Anticonvulsants such as valproate and carbamazepine can stabilize mood in patients who cannot take lithium.
- SSRIs and herbal supplements are not used as primary therapy for bipolar affective disorder.
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