A nurse is talking with the parents of a 2-month-old infant who have chosen to not immunize the infant. Which of the following responses should the nurse make?

Choice A reason: Amitriptyline, a tricyclic antidepressant, typically causes hypotension via alpha-adrenergic blockade, not hypertension. Expecting blood pressure elevation shows misunderstanding, as its cardiovascular effects require monitoring for orthostatic changes, not hypertensive risks, in depression treatment.
Choice B reason: Acknowledging a 2-4 week delay for amitriptyline’s effect shows understanding, as tricyclics increase synaptic serotonin and norepinephrine gradually, requiring neuroplastic changes for mood improvement. This reflects accurate knowledge of the drug’s onset, critical for managing expectations in depression therapy.
Choice C reason: Taking amitriptyline on an empty stomach is incorrect, as food reduces gastrointestinal side effects like nausea. Its absorption is unaffected by food, but taking it with meals improves tolerability, indicating a misunderstanding of administration guidelines for effective therapy.
Choice D reason: Morning dosing of amitriptyline is incorrect, as its sedative effects, via histamine blockade, are best utilized at bedtime to aid sleep. Morning use may cause daytime drowsiness, reducing adherence, indicating a misunderstanding of its pharmacological profile in depression management.

Choice A reason: Advising over-the-counter medications as safe is incorrect, as many, like NSAIDs, increase warfarin’s bleeding risk by inhibiting platelets or affecting liver metabolism. Warfarin’s narrow therapeutic index requires careful management to prevent hemorrhage, making broad safety claims dangerous without specific evaluation.
Choice B reason: Consulting the pharmacist identifies interactions with warfarin, a vitamin K antagonist metabolized by CYP450 enzymes. Many drugs alter warfarin’s efficacy, risking thrombosis or bleeding. Pharmacist expertise ensures safe polypharmacy, maintaining therapeutic INR levels critical for managing pulmonary emboli effectively.
Choice C reason: Recommending warfarin with other medications ignores interaction risks and timing needs. Warfarin’s absorption is unaffected by timing, but CYP450 interactions can alter INR. This advice is irrelevant to safety, missing the need for individualized regimen assessment to prevent complications in anticoagulation therapy.
Choice D reason: Cranberry juice may enhance warfarin’s effect by inhibiting CYP2C9, increasing INR and bleeding risk. Advising its use without monitoring is unsafe, as dietary factors can destabilize anticoagulation, potentially causing hemorrhage in clients with pulmonary emboli, requiring careful dietary guidance.