Questions and answers for the advanced practice psychiatric nurse

The following considerations may also be helpful in handling potential drug-to-drug interactions:

1. Analyze data from a comprehensive database concerning the patient's physical and mental status that include pathophysiology of major organs such as the kidney and liver, genetic factors, drug allergies, developmental stage, and pregnancy.

2. Ask yourself the following questions:

a. What are the direct and physical interactions of each drug?

b. How does GI absorption affect each drug?

c. How does protein binding affect the drug concentration?

d. Which specific receptor sites will the drugs affect? Normally, the displacement of drugs from their receptor sites leads to a pharmacologic effect rather than drug interaction. For instance, a beta blocker, like propanolol (Inderal), may displace a beta agonist, such as albuterol (Proventil), from beta^sup 2^ receptors and increase the risk of bronchospasm or asthma attack (Hardeman et al., 2001; Hartshorn & Tatro, 1999).

3. Consult with the patients other healthcare providers and develop an integrated plan of care that addresses the management of both medical and psychiatric conditions.

As an advanced practice psychiatric nurse, you need to gather these data to use as a guide in the administration and prescription of multiple medications for co-- morbid medical and psychiatric conditions.

References

Hardeman, J.G., Limbird, L.E., & Gilman, A.G. (2001). Goodman & Gilman's The pharmacological basis of therapeutics (10th ed.). New York McGraw-Hill.

Tatro, D.S. (1999). Drug interactikon facts. St. Louis, MO: Facts and Comparisons.

Search terms: Drug interactions, cytochrome, P450, enzymes

Deborah Antai-Otong, MS, RN, CNS, NP, FAAN

Deborah Antai-Otong, MS, RN, CNS, NP, CS, FAAN

Mental Health Provider and Program Specialist Employee Support Program

VA North Texas Health Care System

Dallas, TX

Author contact: Deborah.Antai-otong@med.va.gov, with a copy to the Editor: mary@artwindows.com

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