Psychiatric Medications Q 25
Aira has taken amitriptyline HCL (Elavil) for 3 days, but now complains that it “doesn’t help” and refuses to take it. What should the nurse say or do?
A. Withhold the drug.
B. Record the client’s response.
C. Encourage the client to tell the doctor.
D. Suggest that it takes a while before seeing the results.
Correct Answer: D. Suggest that it takes a while before seeing the results.
The client needs a specific response; that it takes 2 to 3 weeks (a delayed effect) until the therapeutic blood level is reached. Amitriptyline administration comes in various forms, the most common being oral form. The initial dose recommended for depression is 25 mg/day at bedtime, as it can be sedating. For off-label use such as for chronic pain, therapy can initiate at a much lower dose of 10 to 20 mg/day. It can be increased by 25 mg every 3 to 7 days, with a maximum of 150 to 300 mg/day.
Option A: If the dose needs to be adjusted, it is preferable to change the dose at bedtime. Once the patient is stable, amitriptyline should be continued for three months or longer to prevent relapse of depression. In cases of therapy cessation, the clinician should gradually taper to avoid withdrawal.
Option B: In patients with a history of cardiac problems or patients over 50 years of age should have a baseline electrocardiogram. Considering the drug’s side effect profile, the following parameters require monitoring – BMI, liver function test, thyroid function test, and serum amitriptyline concentrations. While a patient is on amitriptyline, one should monitor for an increase in suicidality and unusual behavior changes, especially during the first 1 to 2 months of starting medication or during periods of dosage adjustment.
Option C: When a clinician determines to start a patient on amitriptyline, they should consult a pharmacist to verify the absence of drug-drug interactions, which in the case of amitriptyline, can be significant. Nursing can provide medication counseling, evaluate patient adherence, and monitor for side effects on follow-up visits. If the nurse has any concerns, they should be reported to the clinician promptly.