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.
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Correct Answer is D
Explanation
A. Minimize the amount of fluid taken while on this drug: Increasing fluid intake is actually recommended to manage potential constipation, another common side effect of anticholinergic medications.
B. Discontinue the medication if adverse effects occur: Discontinuing medication without consulting a healthcare provider is not advisable. Patients should be educated to report any adverse effects to their healthcare provider for appropriate management.
C. Take the medication on an empty stomach to enhance absorption: Benztropine is typically taken with food to minimize gastrointestinal side effects. Taking it on an empty stomach may increase the risk of nausea or stomach upset.
D. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth: Anticholinergic medications such as benztropine commonly cause dry mouth as a side effect. Stimulating saliva production with these measures can help alleviate dry mouth symptoms.
Correct Answer is A
Explanation
A. Midazolam: Benzodiazepine with rapid onset of action, often preferred for acute seizure management such as status epilepticus.
B. Carbamazepine: Not typically used for acute seizure management like status epilepticus; more commonly used for maintenance therapy in epilepsy.
C. Diazepam: Benzodiazepine also used for acute seizure management, including status epilepticus. However, midazolam is often preferred due to its faster onset and shorter duration.
D. Valproic acid: Effective for long-term seizure control but not typically used for acute seizure management such as status epilepticus.
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