Nokea
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.
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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 is the longest acting newer antihistamine:
- A. Mequitazine
- B. Loratidine
- C. Astemizole
- D. Terfenadine
Correct Answer: C
Rationale: Astemizole has the longest duration among listed antihistamines.
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.
Following drugs have disulfiram-like reaction when taken with alcohol EXCEPT
- A. Sulfonylureas
- B. Amoxicillin
- C. Metronidazole
- D. Cefoperazone
Correct Answer: B
Rationale: Metronidazole, cefoperazone, and some sulfonylureas cause a disulfiram-like reaction (flushing, nausea) with alcohol by inhibiting aldehyde dehydrogenase; amoxicillin does not.
Which of the following is an II generation sulfonylurea drugs, which are used for the treatment of diabetes mellitus type II:
- A. Chlorpropamide
- B. Tolazamide
- C. Tobutamide
- D. Glipizide
Correct Answer: D
Rationale: Glipizide is a second-generation sulfonylurea, more potent and with fewer side effects than first-generation drugs like chlorpropamide.