A provider has indicated that a serotonin/norepinephrine reuptake ...

[big1devin]

A provider has indicated that a serotonin/norepinephrine reuptake inhibitor (SNRI) will be prescribed for a patient who is experiencing major depression.
 
  When conducting a pretreatment health history, the nurse learns that the patient has a recent history of alcohol abuse. Which SNRI would be contraindicated for this patient? a. Desvenlafaxine Pristiq
  b. Duloxetine Cymbalta
  c. Escitalopram Lexapro
  d. Venlafaxine Effexor SR

Question 2

A patient has been diagnosed with Parkinson's disease (PD) and begins treatment with levodopa/carbidopa Sinemet. After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to:
 
  a. add a dopamine agonist.
  b. discuss the on-off phenomenon.
  c. increase the dose of Sinemet.
  d. re-evaluate the diagnosis.

[tdewitt]

Answer to Question 1

B
Duloxetine can cause elevation of serum transaminases, indicating liver disease. Patients with existing liver disease or alcohol abuse should not receive this drug. This side effect is not likely with desvenlafaxine or venlafaxine. Escitalopram is an SSRI.

Answer to Question 2

D
Patients beginning therapy with levodopa/carbidopa should expect therapeutic effects to occur after several months of treatment. Levodopa is so effective that a diagnosis of PD should be questioned if the patient fails to respond in this time frame. Adding a dopamine agonist is not indicated. The on-off phenomenon occurs when therapeutic effects are present. Increasing the dose of levodopa/carbidopa is not indicated.