A 42-year-old woman with a long history of major depression is in ...

[Bob-Dole]

A 42-year-old woman with a long history of major depression is in an inpatient psychiatric hospital. She has been taking phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI), for her depression.
 
  The therapist writes an order to discontinue the phenelzine and begin fluoxetine (Prozac). Which of the following
  A) Begin educating the client about food restrictions when taking fluoxetine.
  B) Begin educating the client about selective serotonin reuptake inhibitors.
  C) Call the therapist to discuss the need for a washout period before starting fluoxetine.
  D) Note in the medication administration record to check the client's blood pressure for the first 2 days after starting fluoxetine.
  ated?

Question 2

Jennifer is a 38-year-old woman who has been diagnosed with major depressive disorder.
 
  She is being placed on an antidepressant and the nurse has been asked to conduct medication teaching. Which of the following would be appropriate information to provide to Jennifer?
  A) You should notice an immediate improvement in your mood.
  B) You may not notice an improvement in your symptoms for 2 to 6 weeks.
  C) If you do not notice an improvement in your symptoms in 1 to 2 weeks, a different antidepressant will be prescribed.
  D) The antidepressant's ability to affect the neurons in your brain will take between 2 and 6 weeks.

[amy.lauersdorf90]

Answer to Question 1

Ans: C
Feedback:
If the client is switching from an MAOI to fluoxetine, the provider should allow a washout period of at least 5 weeks (half-life of MAOI). Conversely, if a client is switching from fluoxetine to an MAOI, providers should allow a washout period of at least 2 weeks (half-life of fluoxetine) before beginning the MAOI.

Answer to Question 2

Ans: B
Feedback:
In general, all antidepressants act at the level of the neuron. Their effects include changing the receptor itself, altering metabolism and breakdown of the neurochemical, or blocking reuptake of the neurochemical at the presynaptic receptor. These changes occur soon after the medication is administered; however, reduction in depressive signs and symptoms usually takes between 2 to 6 weeks, depending on the drug.