The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient's current medications, the nurse recognizes that interactions may occur with which drugs? (Select all that apply.)
Oral contraceptives
Antihistamines
Warfarin
Opioids
Diuretics
Correct Answer : A,D,E
A. Oral contraceptives: Phenobarbital can decrease the effectiveness of oral contraceptives, increasing the risk of contraceptive failure and unintended pregnancy.
B. Antihistamines: While phenobarbital can induce hepatic enzymes, leading to increased
metabolism of some antihistamines, this interaction is less clinically significant compared to the interactions with oral contraceptives, opioids, and diuretics.
C. Warfarin: Phenobarbital can induce the metabolism of warfarin, potentially reducing its anticoagulant effects and necessitating closer monitoring of international normalized ratio (INR) levels.
D. Opioids: Phenobarbital can increase the metabolism of opioids, leading to reduced analgesic effects and potentially causing inadequate pain control.
E. Diuretics: Phenobarbital can accelerate the metabolism of diuretics, potentially reducing their efficacy and necessitating adjustments in dosage or monitoring of electrolyte levels.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C"]
Explanation
A. Increased heart rate: Sympathetic nervous system stimulation typically leads to increased heart rate as part of the "fight or flight" response.
B. Decrease in urinary bladder muscle tone: Sympathetic stimulation would typically cause relaxation of the urinary bladder, leading to increased muscle tone.
C. Increased blood pressure: Sympathetic nervous system activation results in vasoconstriction and increased cardiac output, leading to elevated blood pressure.
D. Decreased salivation: Sympathetic stimulation can lead to decreased salivation as part of the "fight or flight" response, but it's not a consistent finding.
E. Decreased bowel sounds: Sympathetic activation can inhibit gastrointestinal motility, leading to decreased bowel sounds, but it's not a universal finding in sympathetic stimulation.
Correct Answer is C
Explanation
A. These are adverse effects that usually subside after a few weeks: While some adverse effects of phenobarbital may diminish over time, the symptoms described by the patient are more likely related to its impact on REM sleep.
B. The drug must be stopped immediately because of possible adverse effects: Stopping phenobarbital abruptly can lead to withdrawal symptoms and potential rebound seizures; discontinuation should be done gradually under medical supervision.
C. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress: Phenobarbital is known to disrupt REM sleep, leading to emotional lability, irritability, and difficulty coping with stress.
D. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness: Phenobarbital actually decreases REM sleep, which can lead to disturbances in sleep patterns and mood changes.
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