Question

a nurse is taking a medication history from a client who has angina and is to begin taking ranolazine. the nurse should report which of the following medications in the clients history that can interact with ranolazine? select all that apply. a digoxin b simvastatin c verapamil d amlodipine e nitroglycerin transdermal patch

Explanation:

• Digoxin: Ranolazine can increase digoxin levels, increasing the risk of digoxin toxicity.
• Simvastatin: Ranolazine inhibits the CYP3A4 enzyme, which is involved in simvastatin metabolism. This can lead to increased simvastatin levels and a higher risk of myopathy/rhabdomyolysis.
• Verapamil: Verapamil is a CYP3A4 inhibitor (like ranolazine in some aspects in terms of drug - drug interaction pathways related to metabolism). Co - administration can lead to increased levels of both drugs (verapamil levels increase because of reduced metabolism by CYP3A4, and ranolazine levels may be affected as well), increasing the risk of adverse effects such as bradycardia and hypotension.
• Amlodipine: There is no significant direct interaction between ranolazine and amlodipine that would require reporting in the context of a major drug - drug interaction that affects safety or efficacy in a well - known, clinically significant way.
• Nitroglycerin transdermal patch: There is no significant direct interaction between ranolazine and nitroglycerin transdermal patch that would require reporting in the context of a major drug - drug interaction that affects safety or efficacy in a well - known, clinically significant way.

Answer:

A. Digoxin, B. Simvastatin, C. Verapamil