Inhibition of P-glycoprotein by a drug such as quinidine may lead to:
- A. Decreased therapeutic levels of quinidine
- B. Increased therapeutic levels of quinidine
- C. Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination
- D. Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination
Correct Answer: D
Rationale: Quinidine inhibits P-glycoprotein, increasing levels of drugs like digoxin by reducing efflux, not affecting quinidine itself or lowering digoxin .
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The patient is taking a drug that affects the body by increasing cellular activity. Where does this drug work on the cell?
- A. Receptor sites
- B. Cell membrane
- C. Golgi body
- D. Endoplasmic reticulum
Correct Answer: A
Rationale: Many drugs are thought to act at specific areas on cell membranes called receptor sites. After the receptor site is activated, this in turn activates the enzyme systems to produce certain effects, such as increased or decreased cellular activity, changes in cell membrane permeability, or alterations in cellular metabolism. Receptor sites are generally located on the outside of cells and allow the drug to bypass the cell membrane. The Golgi body and endoplasmic reticulum are not involved in this process.
Which of the following is a side effect of propylthiouracil?
- A. Agranulocytosis
- B. Arrhythmias
- C. Diabetes
- D. Hypertension
Correct Answer: A
Rationale: Propylthiouracil can cause agranulocytosis, a severe reduction in white blood cells, as a serious side effect.
The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done:
- A. The initial dose of glargine is reduced by 20% to avoid hypoglycemia
- B. The initial dose of glargine is 2 to 10 units per day
- C. Patients who have been on high doses of NPH will need tests for insulin antibodies
- D. Obese patients may require more than 100 units per day
Correct Answer: A
Rationale: Switching to glargine reduces the dose by 20% to prevent hypoglycemia due to its steady action vs. NPH peaks.
Twenty-year-old Annie comes to the clinic complaining of copious yellow-green eye discharge. Gram stain indicates she most likely has gonococcal conjunctivitis. While awaiting the culture results, the plan of care should be:
- A. None, wait for the culture results to determine the course of treatment
- B. Ciprofloxacin (Ciloxan) ophthalmic drops
- C. IM ceftriaxone
- D. High-dose oral amoxicillin
Correct Answer: C
Rationale: Gonococcal conjunctivitis requires urgent IM ceftriaxone; waiting risks progression.
A nurse is caring for a child on the pediatric unit. A drug is ordered for the child, but there is no pediatric dose listed for the drug. To make sure that the right dose has been ordered, what will the nurse use to calculate the correct dose?
- A. Surface area
- B. Height
- C. Birth date
- D. Age at gestation
Correct Answer: A
Rationale: Surface area, calculated via nomograms using height and weight, is the most accurate method for pediatric dosing adjustments.
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