When caring for a patient with a sleep-wake disorder, the nurse notes that the patient takes an MAO inhibitor for depression. Which medication order for the patient will the nurse question? Select all that apply
1. Zaleplon (Sonata)
2. Zolpidem (Ambien)
3. Amitriptyline (Elavil)
4. Nortriptyline (Aventyl)
5. Chloral hydrate (Leukeran)
Answer: 3, 4
Explanation: The nurse should question an order of any tricyclic antidepressant (TCA) such as amitriptyline (Elavil) or nortriptyline (Aventyl). TCAs should not be administered along with MAO inhibitors, as this may cause a potentially deadly reaction. All the additional answer choices (zaleplon, zolpidem, and chloral hydrate) are appropriate orders, and the nurse will not question these. However, because chloral hydrate is a CNS depressant and its effects may be potentiated by MAO inhibitors, the patient taking chloral hydrate will require careful monitoring.
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