A nurse on the behavioral health unit is reviewing medication prescriptions for 4 clients. Which combination of medications does the nurse question?

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Clients are often prescribed medications from more than one class to effectively treat anxiety and depression; however, monoamine oxidase inhibitors (MAOIs) (eg, selegiline [Emsam]) interact with many medications, including many antidepressants. Concurrent use of MAOIs with selective serotonin reuptake inhibitors (SSRIs) (eg, escitalopram [Lexapro]) may precipitate life-threatening adverse reactions (eg, serotonin syndrome, neuroleptic malignant syndrome, hypertensive crisis). If a client's prescribed medication regimen will change to or from an MAOI, the existing medication should be tapered and discontinued, followed by a 2-week "washout" period without either medication. The client can then begin taking the new medication. (Options A and D) SSRIs (eg, citalopram [Celexa], escitalopram, sertraline [Zoloft]) can be given safely with benzodiazepines (eg, alprazolam [Xanax], lorazepam [Ativan]) or hypnotics (eg, zolpidem [Ambien]). Benzodiazepines control acute anxiety and SSRIs help treat long-term anxiety without abuse potential. (Option B) Clients with bipolar disorder often need antipsychotic medication (eg, risperidone [Risperdal], haloperidol [Haldol]) to control acute psychosis and lithium for long-term maintenance therapy. Educational objective: Monoamine oxidase inhibitors (MAOIs) (eg, selegiline [Emsam]) interact with many medications, including many antidepressants. MAOIs and selective serotonin reuptake inhibitors should not be given within 2 weeks of each other to prevent adverse reactions (eg, serotonin syndrome, neuroleptic malignant syndrome, hypertensive crisis).

A Nurse on the Behavioral Health Unit Is Reviewing Medication