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The nurse realizes that some herbs interact with selective serotonin reuptake inhibitors. Which herb interaction may cause serotonin syndrome?

A.

feverfew

B.

ma-huang

C.

St. John’s wort

D.

gingko biloba

Answer and Explanation

The Correct Answer is C

Certain herbal supplements can dangerously interact with prescription medications. When combined with selective serotonin reuptake inhibitors (SSRIs), some herbs may increase serotonin levels, putting the patient at risk for serotonin syndrome, a potentially life-threatening condition.

 

C. St. John’s wort
– St. John’s wort is a popular herbal antidepressant that increases serotonin by inhibiting reuptake. When combined with an SSRI, serotonin levels can rise excessively, leading to serotonin syndrome. Symptoms include agitation, confusion, tremor, diaphoresis, hyperreflexia, and hyperthermia. This makes it the most concerning herb to avoid with SSRIs.

 

A. feverfew
– Feverfew is mainly used for migraine prevention. It does not increase serotonin levels significantly and is not strongly associated with serotonin syndrome when combined with SSRIs.

B. ma-huang (ephedra)
– Ephedra is a stimulant herb linked to hypertension, tachycardia, and cardiac complications. Its risk is primarily cardiovascular rather than serotonergic.

D. gingko biloba
– Ginkgo is used to improve memory and circulation. While it increases bleeding risk (especially with anticoagulants), it does not significantly elevate serotonin or interact with SSRIs to cause serotonin syndrome.

Take-Home Points:

  • St. John’s wort + SSRI → serotonin syndrome risk.
  • Patients should always disclose herbal supplement use to prevent drug interactions.
  • Serotonin syndrome is a medical emergency requiring immediate discontinuation of serotonergic agents and supportive care.


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Related Questions

Correct Answer is ["A","B","C"]

Explanation

  • GI upset, confusion, and polyuria are early warning signs of lithium toxicity.
  • Severe symptoms such as ataxia and seizures occur in advanced toxicity.
  • Continuous monitoring of serum lithium levels and client symptoms is essential to maintain safety.

Correct Answer is D

Explanation

Lithium is a mood stabilizer with a narrow therapeutic range. Because lithium is primarily excreted by the kidneys, conditions that alter fluid and electrolyte balance, such as vomiting and diarrhea, can rapidly increase the risk for lithium toxicity. Nurses must assess hydration status and monitor for signs of toxicity in patients experiencing fluid loss.

D. Dehydration — Severe vomiting and diarrhea can lead to fluid depletion, which reduces renal clearance of lithium, increasing the risk of elevated lithium levels and toxicity. Assessment should include monitoring vital signs, intake and output, and signs of hypotension or dizziness.

A. Anxiety — While lithium can affect mood, acute gastrointestinal illness does not directly cause anxiety related to lithium therapy and is less urgent than fluid status.

B. Chest pain — Not a common complication of lithium therapy or fluid loss from GI illness. Any chest pain would warrant separate cardiac evaluation.

C. Agitation — Although agitation can be a symptom of lithium toxicity, in this scenario the primary concern is dehydration that may precipitate toxicity; agitation would be secondary if toxicity develops.

Take-Home Points:

  • Monitor for dehydration and electrolyte imbalance in patients on lithium during illness.
  • Understand that fluid loss can precipitate lithium toxicity.
  • Prompt assessment and intervention can prevent life-threatening complications.

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