Nokea
What needs to happen to the protein-drug complex for the drugs to reach the cells where the drug can act?
- A. The protein-drug complex must break itself into smaller pieces to enter the capillaries.
- B. The binding site on the protein picks up a chemical to make it soluble in the serum.
- C. The drug must break away from the protein-binding site and float freely.
- D. The drug must be dissolved in the plasma so it can enter the capillaries and then the tissues.
Correct Answer: C
Rationale: Most drugs are bound, to some extent, to proteins in the blood to be carried into circulation. The protein-drug complex is relatively large and cannot enter into capillaries and then into tissues to react. The drug must be freed from the protein's binding site at the tissues. This occurs without the introduction of another chemical or by dissolving in it plasma.
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A patient has recently moved from Vermont to Southern Florida. The patient presents to the clinic complaining of dizzy spells and weakness. While conducting the admission assessment, the patient tells the nurse that he have been on the same antihypertensive drug for 6 years and had stable blood pressures and no adverse effects. Since his move, he has been having problems and he feels that the drug is no longer effective. The clinic nurse knows that one possible reason for the change in the effectiveness of the drug could be what?
- A. The impact of the placebo effect on the patients response.
- B. The accumulative effect of the drug if it has been taken for many years.
- C. The impact of the warmer environment on the patients physical status.
- D. Problems with patient compliance with the drug regimen while on vacation.
Correct Answer: C
Rationale: Antihypertensive drugs work to decrease the blood pressure. When a patient goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure falls. If a patient is taking an antihypertensive drug and moves to a warmer climate, there is a chance that the patients blood pressure will drop too low, resulting in dizziness and feelings of weakness. Even mild dehydration could exacerbate these effects. Most antihypertensives are metabolized and excreted and do not accumulate in the body. Patients must be very compliant with their drug regimen on vacation. After several years on an antihypertensive drug, the effects of that drug are known; therefore, the placebo effect should not be an issue.
Cough and cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population:
- A. Older adults
- B. Hypertensive patients
- C. Infants
- D. All of the above
Correct Answer: D
Rationale: Sympathomimetic decongestants like phenylephrine can raise blood pressure or cause adverse effects in older adults, hypertensives, and infants.
A nurse is assessing a client who is taking Amiodarone to treat Atrial Fibrillation. Which of the following findings is a manifestation of Amiodarone toxicity?
- A. Light yellow urine
- B. Report of tinnitus
- C. Productive cough
- D. Blue-gray skin discoloration
Correct Answer: C
Rationale: Productive cough may indicate pulmonary toxicity, a serious amiodarone side effect.
In the presence of pentazocine, a higher concentration of morphine is required to elicit pain relief. Pentazocine by it self has a smaller analgesic effect than does morphine, even at the highest dose, Which of the following is correct regarding these medications?
- A. Pentazocine is a competitive antagonist
- B. Morphine is a full agonist, and pentazocine is a partial agonist
- C. Morphine is less efficacious than is pentazocine
- D. Morphine is less potent than is pentazocine
Correct Answer: B
Rationale: Pentazocine's submaximal effect and antagonism of morphine indicate it is a partial agonist, while morphine is a full agonist.
A 57-year-old man was recently diagnosed with Type-2 diabetes mellitus and placed on a medication. He began having myalgias and feeling sick and later developed respiratory distress, so he went to the hospital. His pH was 7.2, and he had elevated blood lactate levels. Which drug is likely causing his problem?
- A. Acarbose
- B. Glyburide
- C. Metformin
- D. Pioglitazone
Correct Answer: C
Rationale: Metformin can cause lactic acidosis, a rare but serious side effect, presenting with low pH and elevated lactate levels.