Which statement represents the most appropriate instructions for a patient with a past suicide attempt who is prescribed amitriptyline (Elavil), 150 mg PO at bedtime?
a. "You will need to pick up your 7-day supply of medication at the pharmacy each week.".
b. "Your prescription will provide you with a 6-month supply to save you money and time.".
c. "I'm going to strongly suggest that your spouse dispense this medication to you each evening.".
d. "Stop by the clinic each evening for your medication so your emotional state of mind can be assessed.".
A
Amitriptyline (Elavil) is a tricyclic antidepressant (TCA) medication (tertiary amine). The TCAs are very toxic when ingested at levels of 1000 to 3000 mg, and overdosage and suicide attempts with this medication are extremely dangerous and often require emergency medical attention. Because an overdose often requires only a 1-week supply of medication, it is the nurse's responsibility to suggest that the prescription be dispensed in weekly doses. In the above situation, the patient has a history of self-directed lethality, and prudence is the best approach. By asking the patient to help the nurse determine the easiest method of dispensing medication, the nurse allows the patient control and offers respect and mutuality.
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