An older adult patient who is to begin taking imipramine ...

[Diane]

An older adult patient who is to begin taking imipramine (Tofranil) asks the nurse when the drug should be taken. The nurse will instruct the patient to:
 
  a. divide the daily dose into two equal doses 12 hours apart.
  b. take the entire dose at bedtime to minimize sedative effects.
  c. take the medication once daily in the late afternoon.
  d. take the medication once daily in the morning.

Question 2

A patient has been taking fluoxetine (Prozac) for 11 months and reports feeling cured of depression.
 
  The nurse learns that the patient is sleeping well, participates in usual activities, and feels upbeat and energetic most of the time. The patient's weight has returned to normal. What will the nurse tell this patient?
  a. Indefinite drug therapy is necessary to maintain remission.
  b. Discuss gradual withdrawal of the medication with the provider.
  c. Stop the drug while remaining alert for the return of symptoms.
  d. Take a drug holiday to see whether symptoms recur.

[Eunice618]

Answer to Question 1

ANS: A
For many patients, taking the entire dose of a TCA at bedtime is advantageous for facilitating adherence, minimizing daytime sedation, and promoting sleep. However, older adult patients are at greater risk for cardiotoxicity and may experience intolerable effects on the heart if the entire dose is taken at once; therefore, twice-daily dosing is recommended in the elderly.

Answer to Question 2

ANS: B
Abrupt discontinuation of selective serotonin reuptake inhibitors (SSRIs) can cause a withdrawal syndrome, so these drugs should be withdrawn gradually. After symptoms are in remission, treatment should continue for 4 to 9 months to prevent relapse; these drugs are not taken indefinitely. It is incorrect to counsel the patient to stop taking the drug without tapering it. Drug holidays are used to minimize sexual dysfunction side effects, not to monitor symptoms.

[Diane]

TYSM

[Liddy]

Thanks for the timely response, appreciate it