A 78-year-old client with benign prostatic hyperplasia, narrow-angle glaucoma, and recent falls is prescribed amitriptyline for neuropathic pain. Which action should the nurse take?
1Hold the first dose and contact the prescriber to discuss the medication risks and alternatives.✓ Correct answer
2Give half the prescribed dose and increase it gradually if the client remains alert.
3Give the dose at bedtime and use fall precautions to manage the expected sedation.
4Obtain an ECG and give the medication if the corrected QT interval is normal.
Explanation
Amitriptyline is strongly anticholinergic, sedating, and associated with orthostatic hypotension. In this older client it can worsen urinary retention and narrow-angle glaucoma and increase fall risk. The nurse should hold the first dose and contact the prescriber to review safer options. Lowering the dose, giving it at bedtime, or checking only the QT interval does not address the combined anticholinergic and fall hazards.
Clinical reasoning summary Amitriptyline is a strongly anticholinergic tertiary tricyclic antidepressant. BPH, narrow-angle glaucoma, advanced age, and recent falls make urinary retention, acute glaucoma, sedation, orthostasis, and injury especially concerning. Hold and clarify before administration.