A nurse is modifying the diet of a client prescribed an MAOI. Which of the following foods should the nurse eliminate?
Cherries
Cheddar cheese
Chicken
Fresh fish
The Correct Answer is B
A. Cherries do not contain tyramine, which is the compound of concern for clients on MAOIs, so they can be included in the diet.
B. Cheddar cheese is high in tyramine, which can lead to hypertensive crises when consumed by clients taking MAOIs. Therefore, it should be eliminated from the diet.
C. Chicken is generally safe for clients on MAOIs as it does not contain significant amounts of tyramine.
D. Fresh fish is also safe to consume while on MAOIs as long as it is fresh and not aged, fermented, or spoiled, which could contain higher tyramine levels.
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Explanation
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B. Diuretics are generally avoided in patients taking lithium due to the risk of lithium toxicity from altered renal clearance, rather than being a routine prescription for difficulty urinating.
C. Close monitoring of lithium levels is crucial to avoid toxicity and ensure therapeutic efficacy, making this statement correct and essential for the patient’s education.
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Correct Answer is ["B","C","F"]
Explanation
A. Morphine administered intravenously bypasses the gastrointestinal tract and liver, avoiding the first-pass effect entirely.
B. Diphenhydramine in tablet form is absorbed through the gastrointestinal tract and undergoes significant first-pass metabolism in the liver, affecting its bioavailability.
C. Famotidine in tablet form is also subject to first-pass metabolism, which can reduce its effectiveness.
D. Nitroglycerin sublingual tablets are designed to bypass the first-pass metabolism by being absorbed directly into the bloodstream through the mucous membranes.
E. The same applies to nitroglycerin 10mg sublingual tablets; they also avoid the first-pass effect due to sublingual administration.
F. Acetaminophen is taken orally and undergoes first-pass metabolism in the liver, which can significantly affect its overall bioavailability.