Nokea
A 49-year-old woman with a history of hypertension is treated with spironolactone. She has good blood pressure control and in the last 6 months has shown an improvement in her hirsutism. What is the most likely explanation for these findings?
- A. Androgen receptor inhibition of the hair follicle
- B. Drug toxicity
- C. Hypoaldosteronism
- D. Testosterone levels are elevated
Correct Answer: A
Rationale: Spironolactone's anti-androgenic effects inhibit androgen receptors, reducing hirsutism, alongside its aldosterone antagonism for hypertension.
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You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when standing abruptly. The best option for this patient is:
- A. Continue the tamsulosin because the side effect will resolve with continued treatment.
- B. Discontinue the tamsulosin and start doxazosin.
- C. Have him double his fluid intake and stand more slowly.
- D. Prescribe meclizine as needed for the dizziness.
Correct Answer: C
Rationale: Orthostatic hypotension from tamsulosin is managed by rising slowly and ensuring hydration.
The rotavirus vaccine (RotaTeq, Rotarix):
- A. Is a live vaccine that replicates in the small intestine, providing active immunity against rotavirus
- B. Should not be given to infants who are or may be potentially immunocompromised
- C. Is not given to an infant who has a febrile illness (temperature greater than 100.5°F)
- D. All of the above
Correct Answer: D
Rationale: All are true: rotavirus vaccine is live , contraindicated in immunocompromise , and deferred with fever .
A patient is being seen in the clinic for rheumatoid arthritis. Which of the following statements would indicate that she may be developing a complication from her rheumatoid medication, chloroquine (Aralen)?
- A. I have to urinate all the time.'
- B. Sometimes I have blurred vision.'
- C. I have tingling and numbness in my arms and legs.'
- D. Sometimes I feel like I am losing my balance when I walk.'
Correct Answer: B
Rationale: Chloroquine (Aralen) can cause ocular toxicity with blurring of vision, color vision changes, corneal damage, and blindness. Increased urination and tingling and numbness are signs of hyperkalemia and hypokalemia. Loss of balance can be caused by auditory damage due to drug toxicity.
Following are the sign and symptoms of acute morphine poisoning EXCEPT
- A. Respiratory depression with shallow breathing
- B. Hyperthermia
- C. Pin-point pupil
- D. Hypotension
Correct Answer: B
Rationale: Acute morphine poisoning typically causes respiratory depression, miosis (pin-point pupils), and hypotension, but hypothermia, not hyperthermia, is common due to opioid-induced CNS depression.
What concept is considered when generic drugs are substituted for brand name drugs?
- A. Bioavailability
- B. Critical concentration
- C. Distribution
- D. Half-life
Correct Answer: A
Rationale: Bioavailability is the portion of a dose of a drug that reaches the systemic circulation and is available to act on body cells. Binders used in a generic drug may not be the same as those used in the brand name drug. Therefore, the way the body breaks down and uses the drug may differ, which may eliminate a generic drug substitution. Critical concentration is the amount of a drug that is needed to cause a therapeutic effect and should not differ between generic and brand name medications. Distribution is the phase of pharmacokinetics, which involves the movement of a drug to the body's tissues and is the same in generic and brand name drugs. A drug's half-life is the time it takes for the amount of drug to decrease to half the peak level, which should not change when substituting a generic medication.