Learning Cardiovascular Drugs Pharmacology

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During a home visit with a patient diagnosed with schizophrenia the patient tells the community health nurse, “I’m going to stop going to the clinic for my fluphenazine decanoate (Prolixin) shots because I think I’m okay now.” Which statement represents the best understanding of the effect of the patient’s decision on the prognosis?

  • A. “So you think you’re okay now. Let’s discuss why you’ve decided to stop taking your medication.”
  • B. “Your doctor knows what’s best for you. Just look at how well you’re feeling now so don’t stop taking the medication.”
  • C. “It’s true that our philosophy is to use the least amount of medicine that is needed to treat a problem. Tell me why you think that you are okay now.”
  • D. “I’m afraid that you’ll be sick again very soon if you aren’t taking your medication, but you are an adult and entitled to make your own decisions.”
Correct Answer: A

Rationale: The correct answer is A because it demonstrates therapeutic communication and empathy by acknowledging the patient's perspective and inviting further discussion. By exploring the patient's reasons for wanting to stop the medication, the nurse can address underlying concerns and provide education on the importance of medication adherence in managing schizophrenia.

Choice B is incorrect as it undermines the patient's autonomy and fails to address the patient's reasons for stopping the medication. Choice C is partially correct in acknowledging the patient's perspective but lacks the active engagement needed to assess and address the patient's decision. Choice D is incorrect as it expresses fear without exploring the patient's beliefs and reasons, which can lead to resistance and non-compliance.

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Limitation of buspirone is:

  • A. A low therapeutic index
  • B. An extremely slow onset of action
  • C. A high potential of development of physical dependence
  • D. Impairment of mentation or motor functions during working hours
Correct Answer: B

Rationale: Buspirone has a slow onset of action due to its mechanism of action involving serotonin and dopamine receptors. This makes it unsuitable for acute anxiety or panic attacks. The slow onset allows for gradual anxiolytic effects over time. Other choices are incorrect because buspirone has a wide therapeutic index, minimal potential for physical dependence, and does not typically impair mentation or motor functions.

Neuromuscular blockade by both succinylcholine and mivacurium may be prolonged in patients with:

  • A. Renal failure
  • B. An abnormal variant of plasma cholinesterase
  • C. Hepatic disease
  • D. Both b and c
Correct Answer: D

Rationale: The correct answer is D (Both B and C). Succinylcholine and mivacurium are metabolized by plasma cholinesterase. An abnormal variant of plasma cholinesterase (B) can lead to prolonged neuromuscular blockade. Additionally, hepatic disease (C) can impair the metabolism of these drugs, further prolonging their effects. Therefore, in patients with both abnormal plasma cholinesterase and hepatic disease, the neuromuscular blockade can be significantly prolonged. Renal failure (A) does not directly impact the metabolism of succinylcholine and mivacurium, so it is not a significant factor in this context.

Beta-blocking agents have all of the following effects except:

  • A. Increase plasma concentrations of HDL and decrease of VLDL
  • B. Bronchoconstriction
  • C. Decrease of aqueous humor prodaction
  • D. “membrane-stabilizing” action
Correct Answer: A

Rationale: The correct answer is A because beta-blocking agents do not affect plasma lipid levels directly. Beta-blockers can decrease HDL levels and increase VLDL levels, which is opposite to choice A. Bronchoconstriction (B) is a common side effect of non-selective beta-blockers due to their action on beta-2 receptors in the lungs. Decrease in aqueous humor production (C) is a therapeutic effect of beta-blockers in treating glaucoma. "Membrane-stabilizing" action (D) refers to the ability of some beta-blockers to block sodium channels in the cardiac muscle, leading to antiarrhythmic effects.

Sulfonamide potency is decreased in case of co-administration with:

  • A. Oral hypoglycemic agents
  • B. Local anesthetics – derivatives of paraaminobenzoic acid
  • C. Local anesthetics – derivatives of benzoic acid
  • D. Non-narcotic analgesics
Correct Answer: B

Rationale: The correct answer is B: Local anesthetics – derivatives of paraaminobenzoic acid. Sulfonamides and local anesthetics both compete for the same metabolic pathway involving paraaminobenzoic acid, leading to decreased sulfonamide potency. Choices A, C, and D are incorrect because they do not interfere with the same metabolic pathway as sulfonamides, thus not affecting their potency.

Which of the following NSAIDs is an indol derivative?

  • A. Ibuprofen
  • B. Indomethacin
  • C. Meclofenamic acid
  • D. Diclofenac
Correct Answer: B

Rationale: Step-by-step rationale:
1. Indomethacin is an indol derivative due to its chemical structure containing an indole ring.
2. Ibuprofen is a propionic acid derivative, not an indol derivative.
3. Meclofenamic acid is a fenamic acid derivative, not an indol derivative.
4. Diclofenac is an acetic acid derivative, not an indol derivative.

Summary:
B (Indomethacin) is the correct answer as it is the only option that is an indol derivative. A, C, and D are incorrect as they belong to different chemical classes.