Nokea
Which of these beta-blockers is a Class III antiarrhythmic agent?
- A. Metoprolol
- B. Esmolol
- C. Sotalol
- D. Bucindolol
Correct Answer: C
Rationale: Sotalol has both beta-blocking and potassium channel-blocking (Class III) properties, prolonging the action potential.
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The patient, diagnosed with cancer, is receiving morphine sulfate (a potent narcotic pain reliever) to relieve cancer pain. Approximately every 7 days the medication is no longer effective in controlling the patient's pain and a larger dose is needed to have the same effect. How might the nurse explain why this is happening?
- A. Tolerance
- B. Cumulation
- C. Interactions
- D. Addiction
Correct Answer: A
Rationale: The body may develop a tolerance to some drugs over time. Tolerance may arise because of increased biotransformation of the drug, increased resistance to its effects, or other pharmacokinetic factors. When tolerance occurs, the amount of the drug no longer causes the same reaction. Therefore, increasingly larger doses are needed to achieve a therapeutic effect. Cumulative effect occurs when the drug is not properly eliminated and more of the drug is administered, resulting in toxic levels accumulating. Interactions occur when the drug reacts badly with another substance such as food, another drug, or an alternative or complementary therapy. Addiction is the psychological need for a substance.
Identify poor metabolizers of tamoxifen
- A. Not provided in document
- B. Not provided in document
- C. Not provided in document
- D. Not provided in document
Correct Answer: C
Rationale: This question lacks options, but the answer key (ANS: 3) indicates the third choice. Poor metabolizers of tamoxifen can be identified through CYP2D6 genotyping, as this enzyme converts tamoxifen to its active metabolite.
Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be:
- A. This is a parasympathetic response to the vasodilating effects of the drug.
- B. Headaches are common side effects with these drugs. How severe are they?
- C. This is associated with your smoking. Let's work on having you stop smoking.
- D. This is not related to your medication. Are you under a lot of stress?
Correct Answer: B
Rationale: Headaches are a common nitrate side effect due to vasodilation.
An important concept taught by the nurse when providing medication teaching is the need to provide a complete list of medications taken to health care providers to avoid what?
- A. Spending large amounts of money on medications
- B. Allergic reactions to medications
- C. Drug-drug interactions
- D. Critical concentrations of medications in the body
Correct Answer: C
Rationale: It is important that all health care providers have a complete list of the patient's medications to avoid drug-drug interactions caused by one provider ordering a medication, unaware of another medication the patient is taking that could interact with the new prescription. Using the same pharmacist for all prescriptions will also help to prevent this from happening. Informing the provider of all medications taken will not reduce costs of medications, which is best accomplished by requesting generic medications. Allergies should be disclosed to all health care providers as well, but this is not why it is important to provide a complete list of medications taken. Critical concentrations are desirable because that is the amount of drug needed to cause a therapeutic effect, or, in other words, to have the effect the drug is prescribed for.
Which statement is not correct regarding acarbose:
- A. Is for internal use
- B. Inhibiting alfa glucosidase
- C. Inhibits carbohydrates absorbtion in the gut
- D. Is effective for diabetes mellitus type I
Correct Answer: D
Rationale: Acarbose is primarily effective for type 2 diabetes by delaying carbohydrate absorption, not type 1, which relies on insulin deficiency.