BCCL kharkhanda Staff Nurse - 2015
Pharmacology
Medium
Which of the following tests must be done before the patient starts taking imipramine?
Appeared in: BCCL kharkhanda Staff Nurse - 2015
Explanation
- Imipramine is a tricyclic antidepressant (TCA), a class of drugs known for potential cardiotoxic effects.
- TCAs can affect the heart's electrical conduction, leading to arrhythmias and QT interval prolongation.
- A baseline Electrocardiogram (ECG) is essential to screen for pre-existing cardiac conditions that could be exacerbated by the medication.
- This is particularly important for patients over 40 or those with known cardiac risk factors.
Why Other Options Were Wrong
- Option B: A urine protein test assesses for kidney damage (proteinuria) and is not a primary screening tool for imipramine, as the drug's main risk is cardiotoxicity, not nephrotoxicity.
- Option C: A thyroid scan evaluates the structure and function of the thyroid gland. It has no direct relevance to the safety profile of imipramine.
- Option D: While creatinine clearance is a measure of kidney function, and drug dosing may need adjustment in renal impairment, the most critical and life-threatening side effect of imipramine is cardiac. Therefore, an ECG is the most vital pre-treatment test.
Related Visual
Clinical Relevance
- Nursing practice connection: Safe nursing care depends on performing Pre-medication assessment for tricyclic antidepressants (TCAs) in the correct sequence, documenting the action clearly, and monitoring for the expected response.
- A nurse's role includes ensuring that prerequisite tests like an ECG are completed and reviewed before administering the first dose of a high-risk medication like imipramine.
- Patient education is critical. The nurse must teach the patient to report symptoms like dizziness, palpitations, fainting, or irregular heartbeats immediately.
- Nurses should monitor for orthostatic hypotension (a sharp drop in blood pressure upon standing), which is a common side effect of TCAs, by checking blood pressure in lying and standing positions.
How to Approach the Question
- First, identify the drug mentioned in the question: imipramine.
- Recall or determine the drug class of imipramine. It is a tricyclic antidepressant (TCA).
- Access your knowledge about the major side effect profile and toxicities associated with TCAs. The most critical concern is cardiotoxicity.
- Evaluate the given options based on this primary concern. An ECG directly assesses cardiac electrical activity.
- The other options (urine protein, thyroid scan, creatinine clearance) test for kidney or thyroid function, which are not the primary, life-threatening risks associated with starting imipramine.
- Conclude that the test directly related to the most significant risk (cardiac effects) is the most necessary one to perform before initiation.
Concept Tested & Keywords
- Concept Tested: Pre-medication assessment for tricyclic antidepressants (TCAs)
- Stem keywords: imipramine, test, before taking
- Lead-in keywords: Which
- Negative lead-in flag: false
Question ID
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Reference Book
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 205-207
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 3484-3486
E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 1 (pp 26-289 of 579) p. 96-98
Practise the full BCCL kharkhanda Staff Nurse - 2015
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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