Nokea
When describing the various types of medications to a group of nursing students, a nursing instructor would identify which of the following as a source for deriving medications?
- A. Plants
- B. Synthetic sources
- C. Animals
- D. Minerals
Correct Answer: A
Rationale: Plants (A) are a key source, alongside synthetic sources (B), molds (C in original), minerals (D), and animals (E in original), per the text. All are valid, but A is selected as a primary example of natural derivation. The text lists these sources comprehensively, showing medications come from both nature and labs, with plants being a foundational source historically and currently.
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The physician must keep which of the following records when using drugs found on the DEA list of scheduled medications?
- A. a log of all scheduled medications given
- B. copies of the supplier's invoices showing the receipt of the drug
- C. a copy of a BNDD number for each place where the physician administers Schedule II medications
- D. all of the above
Correct Answer: D
Rationale: All of the above' is correct because DEA regulations require physicians to maintain a log of scheduled medications administered (a), keep supplier invoices for receipt (b), and, though BNDD is outdated, modern equivalents like DEA registration numbers per location apply (c interpreted as DEA compliance). 'a' or 'b' alone misses other requirements, and 'c' as BNDD is a misnomer but contextually fits DEA rules. Comprehensive record-keeping prevents diversion, per Controlled Substances Act mandates.
Which of these statins is safe to consume with grapefruit juice?
- A. Rosuvastatin
- B. Atorvastatin
- C. Simvastatin
- D. Lovastatin
Correct Answer: A
Rationale: Rosuvastatin (Choice A) is minimally metabolized by CYP3A4, unaffected by grapefruit juice, making it correct. Atorvastatin (Choice B), simvastatin (Choice C), and lovastatin (Choice D) are CYP3A4 substrates, increasing levels with grapefruit, confirming A.
A patient requires a high dose of a new antihypertensive medication because the new medication has a significant first-pass effect. What does this mean?
- A. The medication must pass through the patient's bloodstream several times to generate a therapeutic effect.
- B. The medication passes through the renal tubules and is excreted in large amounts.
- C. The medication is extensively metabolized in the patient's liver.
- D. The medication is ineffective following the first dose and increasingly effective with each subsequent dose.
Correct Answer: C
Rationale: The first-pass effect refers to the initial metabolism of a drug in the liver after oral administration, before it reaches systemic circulation. Choice C is correct because a significant first-pass effect means the liver extensively metabolizes the drug, reducing its bioavailability, thus requiring a higher dose. Choice A is incorrect as the drug doesn't need multiple passes through the bloodstream; it's about liver metabolism. Choice B is wrong because the first-pass effect involves the liver, not renal tubules. Choice D is false as the effectiveness doesn't increase with subsequent doses due to initial ineffectiveness; it's about metabolism, not tolerance.
Which of the following statements is true regarding the therapeutic index (TI) of a drug?
- A. A drug with a large TI is more dangerous than a drug with a small TI.
- B. The formula for TI is ED50 / LD50.
- C. ED50 is 50% of the effective clinical dose.
- D. TI is the ratio of the median lethal dose to the median effective dose.
Correct Answer: D
Rationale: TI is LD50/ED50 (D), safer with larger values, per the text, making it correct. A is false (large TI is safer), B wrong (formula reversed), C incorrect (ED50 is a dose, not percentage), confirming D.
Which drug is contraindicated in WPW syndrome due to its effect on the AV node?
- A. Digoxin
- B. Amiodarone
- C. Lidocaine
- D. Flecainide
Correct Answer: A
Rationale: A' is correct because digoxin enhances accessory pathway conduction in WPW, risking rapid ventricular rates, per cardiology. 'B' (amiodarone), 'C' (lidocaine), and 'D' (flecainide) are safer—flecainide slows pathways. Digoxin's AV effect is dangerous.