The patient has been receiving escitalopram (Lexapro) for ...

[segrsyd]

The patient has been receiving escitalopram (Lexapro) for treatment of obsessive-compulsive disorder. Unknown to the nurse, the patient has also been self-medicating with St. John's wort.
 
  The patient comes to the office with symptoms of hyperthermia and diaphoresis. Which statement best describes the result of the nurse's assessment?
  1. The patient is experiencing symptoms of St. John's wort toxicity, as the medication was most likely outdated.
  2. The patient has contracted a viral infection. Escitalopram (Lexapro) and St. John's wort are safe to take together.
  3. The patient has not been taking escitalopram (Lexapro) and is experiencing withdrawal.
  4. The patient has combined two antidepressant medications and is experiencing serotonin syndrome.

Question 2

The patient is receiving escitalopram (Lexapro) for treatment of generalized anxiety disorder. The patient asks the nurse, I am just nervous, not depressed. Why am I taking an antidepressant medicine? What is the best response by the nurse?
 
  1. The same brain chemicals are involved with anxiety as well as depression, and these medications are very safe.
  2. You are really depressed; it is just manifested as anxiety. These medications are safer than benzodiazepines.
  3. Your doctor thinks that this is the best treatment for your anxiety, and these medications are safer than benzodiazepines.
  4. The two disorders go together, and if you treat depression, the anxiety goes away.

[Juro]

Answer to Question 1

Correct Answer: 4
Rationale: Use caution with herbal supplements such as St. John's wort, which may increase the effects of escitalopram (Lexapro) and cause serotonin syndrome. The patient's symptoms are consistent with serotonin syndrome, and there is no evidence that the patient has not been taking the escitalopram (Lexapro). The patient's symptoms are consistent with serotonin syndrome, and there is no evidence that the patient's St. John's wort is outdated. The patient's symptoms are consistent with serotonin syndrome. It is not considered safe to combine escitalopram (Lexapro) and St. John's wort.

Answer to Question 2

Correct Answer: 1
Rationale: Antidepressants are frequently used to treat symptoms of anxiety. They reduce anxiety by altering levels of norepinephrine and serotonin. These neurotransmitters are also involved in depression. Selective serotonin reuptake inhibitors (SSRIs) are safer than benzodiazepines, but depression and anxiety are two separate disorders. The patient is being treated for generalized anxiety, this is different from depression. Telling the patient that the doctor knows best is a condescending reply, and does not answer the patient's question.