Nokea
A patient of acute myocardial infarction being treated in intensive care unit developed left ventricular failure with raised central venous pressure. It was decided to use glyceryl trinitrate. Which route/method of administration would be most suitable.
- A. Sublingual
- B. Oral
- C. Intravenous bolus injection
- D. Slow intravenous infusion
Correct Answer: D
Rationale: Slow IV infusion allows precise titration of glyceryl trinitrate to manage preload and LV failure in an ICU setting.
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Select the drug of granulocyte colony-stimulating factor:
- A. Filgrastim
- B. Methotrexate
- C. Erythropoetin
- D. Doxorubicin
Correct Answer: A
Rationale: The correct answer is A, Filgrastim, as it is a granulocyte colony-stimulating factor used to stimulate the production of neutrophils. Filgrastim is commonly prescribed to increase white blood cell count in patients undergoing chemotherapy. Methotrexate (B) is a chemotherapy drug that does not stimulate granulocyte production. Erythropoietin (C) stimulates red blood cell production, not granulocytes. Doxorubicin (D) is an anthracycline antibiotic used in cancer treatment but does not stimulate granulocyte colony formation. Thus, the correct drug for granulocyte colony-stimulating factor is Filgrastim.
Which of the following glucocorticoids have two fluoride atoms in its chemical structure?
- A. Prednisolon
- B. Dexamethasone
- C. Fluocinolone
- D. Triamcinolone
Correct Answer: D
Rationale: The correct answer is D: Triamcinolone. Triamcinolone has two fluoride atoms in its chemical structure, making it a fluorinated glucocorticoid. Prednisolone (A) does not contain any fluoride atoms. Dexamethasone (B) and Fluocinolone (C) each have only one fluoride atom in their chemical structure. Therefore, Triamcinolone is the only option with two fluoride atoms, making it the correct answer.
When applying transdermal nitroglycerin patches, which instruction by the nurse is correct?
- A. Rotate application sites with each dose.
- B. Use only the chest area for application sites.
- C. Temporarily remove the patch if you go swimming.
- D. Apply the patch to the same site each time.
Correct Answer: A
Rationale: The correct answer is A: Rotate application sites with each dose. This instruction is crucial to prevent skin irritation and tolerance development. By rotating sites, the skin has time to recover, ensuring optimal absorption. Choice B is incorrect as using only the chest area can lead to skin irritation. Choice C is incorrect because the patch should not be removed when swimming as it may affect drug delivery. Choice D is incorrect as applying the patch to the same site can cause localized skin reactions and reduced effectiveness. Rotation is key for consistent drug absorption and minimizing skin irritation.
Which of the following drugs is useful in the treatment of pheochromocytoma?
- A. Phenylephrine
- B. Propranolol
- C. Phentolamine
- D. Epinephrine
Correct Answer: C
Rationale: The correct answer is C: Phentolamine. Phentolamine is an alpha-adrenergic antagonist that helps block the effects of excess catecholamines released by pheochromocytoma. It helps to control hypertension and other symptoms associated with pheochromocytoma.
A: Phenylephrine is an alpha-1 adrenergic agonist, which would worsen hypertension in pheochromocytoma.
B: Propranolol is a beta-blocker, which can lead to unopposed alpha-adrenergic effects and exacerbate hypertension in pheochromocytoma.
D: Epinephrine is a catecholamine that would exacerbate symptoms in pheochromocytoma due to its stimulatory effects on alpha and beta adrenergic receptors.
Which of the following hypnotics is preferred in patients with limited hepatic function?
- A. Zolpidem
- B. Amobarbital
- C. Flurozepam
- D. Pentobarbital
Correct Answer: A
Rationale: The correct answer is A: Zolpidem. Zolpidem is preferred in patients with limited hepatic function because it undergoes minimal hepatic metabolism, making it less dependent on liver function for elimination. This reduces the risk of drug accumulation and potential toxicity in patients with hepatic impairment.
Amobarbital (B), Flurazepam (C), and Pentobarbital (D) are all barbiturates that are extensively metabolized in the liver. Therefore, they are not preferred in patients with limited hepatic function as their metabolism can be impaired, leading to increased drug levels and potential toxicity.