A nurse is caring for a client prescribed Furosemide. Which … | MyMerci
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Medication AdministrationPPT
Question
A nurse is caring for a client prescribed Furosemide. Which nursing action is most appropriate regarding monitoring for hypokalemia, ototoxicity, and orthostatic hypotension?
1Stop fluoxetine and wait at least 5 weeks before starting tranylcypromine, then begin a tyramine-restricted diet on day 1 of the MAOI.
2No washout is needed when switching from fluoxetine to tranylcypromine; the risk of serotonin syndrome is minimal with this specific combination.
3Take fluoxetine and tranylcypromine concurrently for one week, then discontinue fluoxetine; this bridging strategy prevents withdrawal and depressive relapse.✓ Correct answer
4Stop fluoxetine in the morning and start tranylcypromine that same evening; this brief gap is sufficient to prevent serotonin syndrome and allows continuous treatment.
Explanation
When administering Furosemide, key nursing considerations include monitoring patient status, checking critical laboratory values, and providing appropriate safety education. Unsafe practices such as stopping medications abruptly or doubling missed doses are incorrect.
Other MAOI washout: 14 days from sertraline, paroxetine, escitalopram, citalopram, venlafaxine, duloxetine, TCAs; 5 weeks from fluoxetine; 24 hours from SSRIs to most other antidepressants is NOT enough when transitioning to a MAOI.
Clinical scenario
Scenario 38-year-old, refractory MDD, on fluoxetine 20 mg PO daily for 4 weeks with no symptomatic response. Prescriber plans to switch to tranylcypromine. No SI/HI today, no medical contraindications, normal LFTs and BP, and willing to follow dietary restrictions. Other meds: oral contraceptive, multivitamin. No OTC decongestants.
Key concepts
MAOI washout periods — Standard 14-day washout between most antidepressants and a MAOI in either direction. Exception: fluoxetine requires 5 weeks before starting a MAOI because norfluoxetine has a half-life of 7–15 days.
Serotonin syndrome — Triad of mental status change, autonomic instability, and neuromuscular hyperactivity (clonus, hyperreflexia, tremor) caused by stacking serotonergic agents (SSRI/SNRI/TCA + MAOI/tramadol/triptan/St. John wort/linezolid). Treatment: stop offending drugs, supportive care, cyproheptadine in severe cases.
MAOI patient education — Tyramine-restricted diet from day 1 of MAOI therapy, MAOI wallet card with emergency drug list, avoid OTC sympathomimetics (pseudoephedrine, phenylephrine), no meperidine or dextromethorphan, sit/stand slowly for orthostatic hypotension, report severe headache or chest pain immediately.