Nokea
An disorder develops lactic acidosis, and nearly dies, as a result of an uncommon but serious adverse response to therapy with an 'endocrine' drug. Which of the following was the most likely cause of this severe problem?
- A. Insulin glargine, prescribed for Type 1 diabetes mellitus
- B. Levothyroxine, prescribed to maintain euthyroid status following thyroidectomy
- C. Metformin, prescribed for Type 2 diabetes mellitus
- D. Propylthiouracil, prescribed for hyperthyroidism
Correct Answer: C
Rationale: Metformin is the most likely cause of lactic acidosis, a rare but life-threatening complication.
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A patient who has tuberculosis asks the nurse why three drugs are used to treat this disease. The nurse will explain that multi-drug therapy is used to reduce
- A. disease relapse
- B. drug hypersensitivity reactions
- C. drug resistance
- D. drug adverse effects
Correct Answer: C
Rationale: Multi-drug therapy prevents TB resistance; it doesn't directly reduce relapse , hypersensitivity , or side effects . Without multi-drug therapy, patients easily develop resistance to antitubercular drugs.
Larry has heart failure, which is being treated with digoxin because it exhibits:
- A. Negative inotropism
- B. Positive chronotropism
- C. Both 1 and 2
- D. Neither 1 nor 2
Correct Answer: D
Rationale: Digoxin has positive inotropic effects, increasing contractility, not negative or chronotropic.
Anaphylactic shock is a:
- A. Type I reaction, called immediate hypersensitivity reaction
- B. Type II reaction, called cytotoxic hypersensitivity reaction
- C. Type III allergic reaction, called immune complex hypersensitivity
- D. Type IV allergic reaction, called delayed hypersensitivity reaction
Correct Answer: A
Rationale: Anaphylactic shock is a Type I immediate hypersensitivity reaction , IgE-mediated, unlike cytotoxic (II), immune complex (III), or delayed (IV).
A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this is due to:
- 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. Once in 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.
All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black Box Warning regarding:
- A. Potential for causing life-threatening GI bleeds
- B. Increased risk of developing systemic arthritis with prolonged use
- C. Risk of life-threatening rashes, including Stevens-Johnson
- D. Potential for transient changes in serum glucose
Correct Answer: A
Rationale: NSAIDs carry a Black Box Warning for GI bleeding risk; rashes or glucose aren't highlighted.