The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan) for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as previously. The nurse will

A) Are no longer approved for treating depression: MAO inhibitors (MAOIs) are still approved and used to treat depression, especially in cases where other medications have not been effective. They are not considered obsolete, though their use has become less common due to the availability of safer, more tolerable options. This is not the primary reason why MAOIs may not be prescribed.

B) Are more expensive than other antidepressants: While cost can be a factor in medication choice, it is not the primary reason why MAO inhibitors are less frequently prescribed for depression. There are other more significant concerns, such as side effects and dietary restrictions, that make other medications a preferred first-line choice.

C) Require strict dietary restrictions: This is the most accurate explanation. MAO inhibitors can cause dangerous interactions with certain foods that contain high levels of tyramine, such as aged cheeses, cured meats, and fermented products. Consuming these foods while on an MAOI can lead to a hypertensive crisis, which is a life-threatening condition. Because of these dietary restrictions, patients on MAOIs must adhere to a strict diet, which can be challenging to manage.

D) Can cause profound hypotension: While hypotension can occur as a side effect of MAOIs, it is not the most significant concern. The more serious risk with MAOIs is the potential for a hypertensive crisis due to dietary interactions with tyramine-containing foods, rather than hypotension. Therefore, the dietary restrictions are a more pressing issue than the risk of hypotension.

A) Parkinson disease is characterized by an imbalance of dopamine and acetylcholine:
The decrease in dopamine results in an imbalance between dopamine and acetylcholine. Normally, dopamine and acetylcholine work in a balanced manner to regulate motor control. As dopamine levels decrease in Parkinson's disease, acetylcholine's effects become more prominent, leading to motor symptoms such as tremors, rigidity, and bradykinesia (slowness of movement).

B) Parkinson disease involves increased dopamine production and decreased acetylcholine:
This statement is incorrect. In Parkinson's disease, there is actually a decrease in dopamine production, not an increase. The disease is characterized by the degeneration of dopamine-producing neurons, leading to the motor symptoms typical of Parkinsonism. The imbalance in Parkinson's disease is primarily one of decreased dopamine and relatively increased acetylcholine activity.

C) Alzheimer disease is caused by decreased amounts of dopamine and degeneration of cholinergic neurons:
While Alzheimer's disease does involve a degeneration of cholinergic neurons (specifically those that release acetylcholine), the primary pathology is related to the accumulation of amyloid plaques and tau tangles, not primarily a decrease in dopamine. Alzheimer's disease is primarily associated with a deficiency in acetylcholine, not dopamine, leading to cognitive impairments, rather than motor deficits.

D) Alzheimer disease involves a possible excess of acetylcholine and neuritic plaques:
This statement is incorrect. Alzheimer's disease is characterized by a deficiency of acetylcholine, which plays a crucial role in memory and cognitive function. The hallmark pathologic features of Alzheimer's disease include the presence of neuritic plaques (formed from amyloid beta) and neurofibrillary tangles (composed of tau protein), not an excess of acetylcholine.