A nurse is obtaining a drug history from an older adult patient who is taking multiple medications prescribed by different providers. Which two medications taken together are a reason for concern?
a. Acetaminophen (Tylenol) and oxycodone
b. Amitriptyline (Elavil) and diphenhydramine (Benadryl)
c. Fexofenadine (Allegra) and an over-the-counter laxative
d. Zolpidem (Ambien) and sertraline (Zoloft)
ANS: B
Both amitriptyline and diphenhydramine are on the BEERS list, amitriptyline for anticholinergic effects and diphenhydramine because it causes blurred vision. Additionally, they both have CNS effects that can compound each other when the drugs are given together. Acetaminophen and oxycodone are both acceptable and may be given together. Fexofenadine is a second-generation antihistamine with fewer side effects, and it is not contraindicated for use with a laxative. Zolpidem is a sedative that has less risk of physical dependence and less risk of confusion, falls, and cognitive impairment; sertraline is a safer antidepressant, because it has a shorter half-life than others.
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