Report chest pain, palpitations, severe headache, or markedly elevated blood pressure.
Before you read
Test yourself first: 2 questions
Question 1 of 2
A nurse is teaching a client about phenelzine, an MAOI. Which over-the-counter medication should the nurse instruct the client to avoid?
Answer: A. Decongestants containing pseudoephedrine or phenylephrine are sympathomimetics and, combined with an MAOI, can precipitate a hypertensive crisis. Clients on MAOIs must check with the provider before any OTC cold remedy. Plain acetaminophen, calcium, and stool softeners are generally acceptable.
Question 2 of 2
A client is prescribed an MAOI. The nurse reviews the medication list for dangerous interactions. Which combination is contraindicated and could cause a hypertensive crisis or serotonin syndrome?
Answer: A. MAOIs must not be combined with sympathomimetics or serotonergic drugs. Combining an MAOI with an SSRI, certain decongestants (pseudoephedrine), meperidine, or other antidepressants can cause hypertensive crisis or serotonin syndrome. A washout period (often 14 days, or 5 weeks for fluoxetine) is required between an MAOI and an SSRI.
Keep the streak going with more questions like these, each with a full rationale.
What is pseudoephedrine?
Because it stimulates the cardiovascular and central nervous systems, it raises blood pressure and heart rate. It is sold behind the pharmacy counter because it can be diverted to make methamphetamine.
Key points to remember
- It is a vasoconstrictor that relieves nasal and sinus congestion.
- It can raise blood pressure and heart rate and cause insomnia, nervousness, and tremor.
- It is contraindicated or used cautiously in hypertension, heart disease, hyperthyroidism, and severe coronary artery disease.
- Avoid late-day dosing because it can cause insomnia.
- Purchase is restricted/logged due to methamphetamine diversion.
Signs & symptoms
- Insomnia, nervousness, palpitations
- ↑ BP, ↑ HR, tremor
Nursing priorities
- Assess baseline blood pressure and heart rate, especially in cardiac or hypertensive patients.
- Question use in patients with uncontrolled hypertension or heart disease and notify the provider.
- Advise taking the last dose several hours before bedtime to avoid insomnia.
- Teach that it is for short-term use and not a long-term decongestant solution.
Patient teaching
- Do not take close to bedtime, as it can keep you awake.
- Tell your provider if you have high blood pressure, heart problems, or thyroid disease before using it.
- Stop and call your provider for chest pain, racing heart, or severe headache.
Red flags: report now
- Report chest pain, palpitations, severe headache, or markedly elevated blood pressure.
- Never give to a patient with uncontrolled hypertension or recent MAOI use.
References
Clinical references for this topic
