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The nurse is assigned a 49-year-old female client in the primary care office for a wellness visit. The nurse assesses the client, documents nurses notes, and reviews the medication administration record for potential interactions. The nurse should be most concern with the potential interaction between __and _.
Complete the sentence by choosing one answer from each option in the drop-down list below:
Medication Reconciliation:

St. John's wort 450 mg by mouth twice daily

Gabapentin 400 mg by mouth twice daily

Aspirin 81 mg by mouth daily

Atorvastatin 80 mg by mouth daily

Lisinopril 5 mg by mouth daily

Warfarin 5 mg by mouth daily

Ginger 5mg by mouth daily

Valerian 10mg by mouth daily

Answer and Explanation

Correct Answer : A,F

A. St. John's wort 450 mg by mouth twice daily: St. John's wort is known to be a potent inducer of cytochrome P450 enzymes and can significantly reduce the effectiveness of warfarin by increasing its metabolism. This interaction can lead to subtherapeutic levels of warfarin and an increased risk of thromboembolic events.

B. Gabapentin 400 mg by mouth twice daily: While gabapentin can interact with other medications, its interactions with warfarin or St. John's wort are generally not as significant as those between warfarin and St. John's wort.

C. Aspirin 81 mg by mouth daily: Aspirin has anticoagulant properties and can have interactions with warfarin. However, the interaction with St. John's wort is less pronounced compared to the interaction between warfarin and St. John's wort.

D. Atorvastatin 80 mg by mouth daily: Atorvastatin primarily affects lipid levels and has different metabolic pathways compared to warfarin. It does not have a strong interaction with St. John's wort.

E. Lisinopril 5 mg by mouth daily: Lisinopril is an ACE inhibitor and does not have significant interactions with St. John's wort or warfarin.

F. Warfarin 5 mg by mouth daily. Warfarin is an anticoagulant that requires careful monitoring due to its interactions with various substances that can either increase the risk of bleeding or decrease its effectiveness.

G. Ginger 5 mg by mouth daily: Ginger can affect platelet function but is not as significant in interaction with warfarin as St. John's wort.

H. Valerian 10 mg by mouth daily: Valerian may have mild interactions with central nervous system depressants but does not have significant interactions with warfarin or St. John's wort.

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Correct Answer is C

Explanation

A. Increase the duration of action of the medication:
A loading dose is not intended to increase the duration of action of a medication. Instead, it aims to rapidly achieve therapeutic levels in the bloodstream. The duration of action is primarily influenced by the drug's half-life and how it's metabolized and excreted, rather than the initial dose.

B. Decrease the frequency of subsequent doses:
The primary goal of a loading dose is to reach therapeutic levels quickly, not necessarily to alter the frequency of future doses. While a loading dose can help achieve therapeutic levels faster, the dosing schedule is determined by the drug's pharmacokinetics and the condition being treated.

C. Achieve therapeutic drug levels more rapidly:
The main purpose of a loading dose is to quickly achieve a concentration of the medication in the blood that is sufficient to be therapeutic. By giving a larger initial dose, the medication reaches effective levels faster compared to gradually reaching those levels with smaller, incremental doses.

D. Minimize the risk of adverse effects:
Minimizing adverse effects is not the primary aim of a loading dose. While achieving therapeutic levels quickly may indirectly help in reducing symptoms and improving outcomes, the main purpose of a loading dose is to reach effective drug levels promptly, not specifically to reduce adverse effects.

A. Wait for at least another 30 minutes before calling to have the level drawn. B. Schedule the level to be drawn in 8 hours C. Call the lab to have the medication level drawn immediately D. Arrange for the level to be drawn tomorrow since the peak time has passed.

Correct Answer is A

Explanation

A. Wait for at least another 30 minutes before calling to have the level drawn:
For oral medications, peak drug levels are typically drawn 1 to 2 hours after administration, depending on the medication's pharmacokinetics. Since the client took the medication only 30 minutes ago, it is premature to draw the level now. Waiting an additional 30 minutes would align with the typical peak times for oral medications, ensuring that the drug level reflects its peak concentration.

B. Schedule the level to be drawn in 8 hours:
Drawing the peak level 8 hours after administration would likely be too late, as most oral medications reach their peak concentration within 1 to 2 hours. Scheduling the level for 8 hours later may result in an inaccurate measurement of the peak drug level, leading to potentially misleading clinical information.

C. Call the lab to have the medication level drawn immediately:
Drawing the level immediately after 30 minutes may not provide an accurate representation of the peak drug level. Oral medications generally reach peak levels later, and an early draw could result in a falsely low measurement that does not reflect the drug's maximum concentration.

D. Arrange for the level to be drawn tomorrow since the peak time has passed:
The peak time has not passed, as the medication was only administered 30 minutes ago. Drawing the level tomorrow would be far too late to assess the peak concentration accurately, which is essential for evaluating the effectiveness and safety of the medication.

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Correct Answer is C

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Correct Answer is A

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