Question

The nurse is preparing to discharge a client with a prescription for tranylcypromine (Parnate). Which statement indicates that the client needs further teaching? A. "I need to avoid eating bananas." B. "I should be less depressed in two to three weeks." C. "I can continue to use St. John's wort." D. "I need to avoid some sandwich meats."

Short answer

A. "I need to avoid eating bananas." B. "I should be less depressed in two to three weeks." C. "I can continue to use St. John's wort." D. "I need to avoid some sandwich meats." Answer: C. "I can continue to use St. John's wort."

Step-by-step solution

Analyze Statement A

Statement A: "I need to avoid eating bananas." - This statement is correct. Tranylcypromine is a monoamine oxidase inhibitor (MAOI), which means that the client should avoid tyramine-rich foods like bananas. The consumption of such foods could cause hypertensive crisis. No further teaching is needed for this statement.

Analyze Statement B

Statement B: "I should be less depressed in two to three weeks." - This statement is correct. Tranylcypromine, as an antidepressant, typically takes about 2-3 weeks to show noticeable effects on a person's mood. No further teaching is needed for this statement.

Analyze Statement C

Statement C: "I can continue to use St. John's wort." - This statement is incorrect. St. John's wort is an herbal supplement that can interact with tranylcypromine, increasing the risk of potentially dangerous side effects like serotonin syndrome. The client needs further teaching regarding the potential risks of combining these two substances.

Analyze Statement D

Statement D: "I need to avoid some sandwich meats." - This statement is correct. As mentioned before, tranylcypromine is a monoamine oxidase inhibitor (MAOI), which means that the client should avoid tyramine-rich foods like certain sandwich meats, such as salami or pepperoni. No further teaching is needed for this statement.

Conclusion

Based on the analysis, Statement C ("I can continue to use St. John's wort.") is the one that indicates the client needs further teaching.

Key concepts

Patient Education

Patient education is a crucial part of nursing care, especially for patients being discharged with new prescriptions. It involves ensuring that patients understand their medications, how to take them, potential side effects, and interactions with other substances. Effective patient education can help prevent medication errors and enhance health outcomes.

• Explain the purpose and effects of the medication to the patient.
• Discuss the importance of following dosage instructions.
• Highlight the need to avoid certain foods or medications that may interact adversely.

Good communication is key. Patients should feel comfortable asking questions and nurses should provide thorough, understandable answers to foster confidence in managing health at home.

Medication Interactions

Medication interactions occur when a drug affects the activity of another drug, often leading to enhanced or reduced effects or increased risk of adverse effects. These can be particularly dangerous, so understanding them is critical.
In the context of tranylcypromine, a monoamine oxidase inhibitor (MAOI), interaction risks are significant.

• MAOIs like tranylcypromine can interact with other antidepressants, herbal supplements, and over-the-counter medications.
• Foods containing tyramine, like certain cheeses, wines, and cured meats, can cause dangerous increases in blood pressure if taken with MAOIs.
• Patients need to be informed about these interactions to avoid life-threatening conditions like hypertensive crises or serotonin syndrome.

Monoamine Oxidase Inhibitors

Monoamine oxidase inhibitors (MAOIs) are a class of antidepressant medications that work by blocking the enzyme monoamine oxidase, which breaks down neurotransmitters like serotonin and norepinephrine in the brain. By inhibiting this enzyme, MAOIs can help increase levels of these mood-influencing chemicals, potentially reducing symptoms of depression.
Despite their effectiveness, MAOIs are not typically first-line treatments due to their significant dietary and drug interaction risks.

• They require strict dietary restrictions to avoid hypertensive crises from tyramine-rich foods.
• Patients must avoid several other medications due to potential severe interactions.
• The complexity of managing MAOIs means that thorough patient education is essential.

Antidepressant Medications

Antidepressant medications are used to treat depressive disorders by altering the balance of neurotransmitters in the brain, thereby improving mood and emotional state.
There are several types of antidepressants, each affecting brain chemistry differently and coming with unique side-effect profiles.

• Common classes include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs).
• MAOIs, though effective, are less commonly prescribed due to their dietary restrictions and interaction concerns.
• Patients should be monitored closely for side effects, and any new or severe symptoms should be reported to a healthcare provider immediately.