A client with depression has been taking citalopram, an SSRI, for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response?
"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."
"Herbal remedies often contain unknown doses of the desired ingredient, which can be dangerous."
"It's very important that you not take the St. John's wort at the same time of day as your antidepressant."
"It's very important that you comply with your prescribed treatment."
The Correct Answer is A
A. "There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." is correct; St. John's wort can reduce the effectiveness of SSRIs and may increase the risk of serotonin syndrome, making it vital for the nurse to address this safety concern.
B. "Herbal remedies often contain unknown doses of the desired ingredient, which can be dangerous." is a valid point, but it does not specifically address the interaction with the client’s current medication.
C. "It's very important that you not take the St. John's wort at the same time of day as your antidepressant." is misleading; the concern is not just about timing but about taking both together at all.
D. "It's very important that you comply with your prescribed treatment." while true, this response does not directly address the specific risks associated with combining St. John's wort and citalopram.
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Correct Answer is B
Explanation
A. A drug that binds tightly to protein is typically released slowly, not quickly, as it remains bound in circulation.
B. Tight binding to proteins usually results in a prolonged duration of action since the drug is released gradually into the bloodstream, leading to sustained therapeutic effects.
C. Drugs that bind tightly to protein are generally not excreted quickly; they remain in circulation longer due to the binding.
D. While toxicity can occur with any drug, tight protein binding does not inherently lead to toxicity; it primarily affects the pharmacokinetics of the drug.
Correct Answer is B
Explanation
A. "I will take this medication at bedtime to help with my symptoms." is correct; famotidine is often taken at bedtime to reduce nocturnal gastric acid secretion and help manage symptoms.
B. "I can take this medication with antacids for faster relief." is incorrect; antacids can interfere with the absorption of famotidine, and patients should be advised to separate the doses by at least an hour.
C. "I should avoid alcohol while taking this medication." is correct; alcohol can increase the risk of gastrointestinal irritation and should generally be avoided.
D. "I will monitor for signs of unusual bleeding or bruising." is correct; while famotidine is not typically associated with bleeding risks, monitoring for signs of unusual bleeding is a good practice when taking any medication, particularly in patients with risk factors.