When teaching a patient about estrogen therapy, which drug(s) will the nurse identify as causing drug interactions? (Select all that apply.)
a. Diazepam (Valium)
b. Warfarin (Coumadin)
c. Thyroid hormones
d. Phenytoin (Dilantin)
e. Acetaminophen (Tylenol)
ANS: B, C, D
Estrogen may diminish the anticoagulant effects of warfarin. Monitor the prothrombin time and increase the dosage of warfarin, if necessary. Patients who have no thyroid function and who start estrogen therapy may require an increase in thyroid hormone dosage. Estrogens increase thyroid-binding globulin levels, which reduce the level of circulating free T4. The total level of T4 is either normal or increased. Do not adjust the thyroid dosage until the patient shows clinical signs of hypothyroidism. Estrogens may inhibit the metabolism of phenytoin, resulting in phenytoin toxicity. Monitor patients with concurrent therapy for signs of phenytoin toxicity (e.g., nystagmus, sedation, lethargy). Serum levels may be ordered, and a reduced dosage of phenytoin may be required. There are no drug interactions with estrogen and diazepam or acetaminophen.
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