A nurse is assessing a client who is taking phenelzine and reports eating aged cheese. Which of the following is a manifestation of an interaction between the medication and the food?
A.
Somnolence
B.
Diarrhea
C.
Bradycardia
D.
Hypertension
The Correct Answer and Explanation is:
The correct answer is D. Hypertension.
Explanation:
Phenelzine is a monoamine oxidase inhibitor (MAOI) used primarily to treat depression. MAOIs work by inhibiting the enzyme monoamine oxidase, which breaks down neurotransmitters such as serotonin, norepinephrine, and dopamine. This inhibition increases the levels of these neurotransmitters in the brain, which helps alleviate depressive symptoms. However, MAOIs also affect the metabolism of tyramine, a naturally occurring substance in certain foods.
Tyramine is found in various aged and fermented foods, including aged cheeses, cured meats, and some alcoholic beverages. When a person taking an MAOI consumes foods high in tyramine, it can lead to a significant and potentially dangerous interaction. This is because the inhibited monoamine oxidase enzyme cannot effectively break down tyramine, leading to an excessive accumulation of tyramine in the body.
The excess tyramine can cause a hypertensive crisis, a severe increase in blood pressure that can be life-threatening. This reaction is due to tyramine stimulating the release of norepinephrine, which causes vasoconstriction and increases blood pressure. Symptoms of a hypertensive crisis can include severe headache, nausea, vomiting, sweating, palpitations, and even potentially dangerous increases in blood pressure.
Given this risk, clients taking MAOIs like phenelzine are advised to avoid foods high in tyramine to prevent such interactions.
In contrast:
- Somnolence (A) is not a typical manifestation of tyramine interaction.
- Diarrhea (B) is not commonly associated with tyramine reactions.
- Bradycardia (C) is less likely to occur with tyramine interactions, as the reaction typically involves hypertension rather than a slowed heart rate.
Therefore, hypertension is the primary and most concerning manifestation of an interaction between phenelzine and aged cheese, emphasizing the need for dietary restrictions while on MAOIs.