Nokea
A young adult female who is taking metronidazole (Flagyl) to treat trichomoniasis calls the nurse to report severe headache, flushing, palpitations, cramping, and nausea. What will the nurse do next?
- A. Ask about alcohol consumption
- B. Reassure her that these are harmless side effects
- C. Tell her that this signals a worsening of her infection
- D. Tell her to go to the emergency department immediately
Correct Answer: A
Rationale: Metronidazole with alcohol causes a disulfiram-like reaction (symptoms listed); it's not infection worsening or harmless . Patients who are taking metronidazole can experience a disulfiram-like reaction when they drink alcohol.
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Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her?
- A. Valproate is safe during all trimesters of pregnancy.
- B. She can get pregnant while taking valproate, but she should take adequate folic acid.
- C. Valproate is not safe at any time during pregnancy.
- D. Valproate is a known teratogen, but may be taken after the first trimester if necessary.
Correct Answer: D
Rationale: Valproate is teratogenic (e.g., neural tube defects) but may be used post-first trimester if essential.
Drugs mostly cross biological membranes by
- A. Passive diffusion
- B. Active diffusion
- C. Active transport
- D. Carrier mediated transport
Correct Answer: A
Rationale: Most drugs cross membranes via passive diffusion based on concentration gradients.
A nurse is caring for a patient who has been receiving a drug by the intramuscular route but will receive the drug orally after discharge. How does the nurse explain the increased dosage prescribed for the oral dose?
- A. Passive diffusion
- B. Active transport
- C. Glomerular filtration
- D. First-pass effect
Correct Answer: D
Rationale: The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. After reaching the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.
Which of the following beta-blockers has intrinsic sympathomimetic activity (ISA)?
- A. Bisoprolol
- B. Timolol
- C. Pindolol
- D. Propanolol
Correct Answer: C
Rationale: Pindolol has ISA, partially stimulating beta receptors while blocking them, reducing bradycardia risk.
The following drug when used for prolonged period in the maintenance treatment of tonic-clonic seizures can lead to increased metabolism of warfarin like drugs:
- A. Phenobarbitone
- B. Meprobamate
- C. Chlordiazepoxide
- D. Triazolam
Correct Answer: A
Rationale: Phenobarbitone induces CYP450, increasing warfarin metabolism.