MSN-611-Advanced Pharmacology Across The Life Span

Correct Answer: D. Atomoxetine

Explanation:

Atomoxetine is a non-stimulant medication used to treat Attention Deficit Hyperactivity Disorder (ADHD). Unlike methylphenidate, amphetamine, and modafinil, which are stimulant medications and classified as controlled substances due to their potential for abuse and addiction, atomoxetine is not classified as a controlled substance. This is because atomoxetine does not have the same potential for abuse or dependence as stimulants. Instead, it works by inhibiting the reuptake of norepinephrine in the brain, which helps with ADHD symptoms without the risks associated with stimulant medications.

Why the Other Options Are Incorrect:

A. Methylphenidate

Methylphenidate is a stimulant medication commonly used to treat ADHD and narcolepsy. Due to its potential for abuse and addiction, it is classified as a Schedule II controlled substance.

B. Modafinil

Modafinil is a wakefulness-promoting agent used to treat conditions like narcolepsy, obstructive sleep apnea, and shift work sleep disorder. It is classified as a Schedule IV controlled substance due to its potential for abuse, though it is considered to have a much lower abuse potential compared to other stimulants.

C. Amphetamine

Amphetamine is another stimulant medication used to treat ADHD and narcolepsy. Like methylphenidate, it is classified as a Schedule II controlled substance due to its high potential for abuse and dependence.

Correct Answer: B. Electrolyte imbalance

Explanation:

When treating a patient with IV furosemide, a loop diuretic, the most concerning side effect is the electrolyte imbalance that can result from its use. Furosemide works by increasing the excretion of sodium, potassium, chloride, and water from the kidneys, leading to diuresis. This can cause significant depletion of electrolytes, such as hypokalemia (low potassium), hyponatremia (low sodium), hypocalcemia (low calcium), and hypomagnesemia (low magnesium). These imbalances can lead to life-threatening complications such as arrhythmias, muscle weakness, or severe dehydration, making it the primary concern for the APRN when using furosemide.

Why the Other Options Are Incorrect:

A. Sexual dysfunction

While sexual dysfunction can occur as a side effect of certain medications, sexual dysfunction is not a common or primary concern when using furosemide. This side effect is more frequently associated with medications like antihypertensives, antidepressants, or certain diuretics, but it is not the primary risk when treating with IV furosemide.

C. Teratogenicity

Teratogenicity refers to the ability of a substance to cause birth defects. Furosemide is not classified as teratogenic; however, it should be used cautiously in pregnancy and is generally not recommended unless absolutely necessary. While it is important to be cautious with any medication during pregnancy, teratogenicity is not the primary concern when treating with IV furosemide, especially if the patient is not pregnant.

D. Hepatotoxicity

Hepatotoxicity refers to liver damage caused by a drug. Furosemide can cause some liver-related issues, particularly in patients with pre-existing liver disease, but it is not a common or primary concern in patients being treated with IV furosemide. The electrolyte imbalances and dehydration associated with furosemide are much more immediate concerns for the APRN.

Correct Answer: A. Second generation antipsychotics have a reduced risk of causing EPS

Explanation:

Antipsychotic medications are commonly classified into two categories: first-generation antipsychotics (FGA) and second-generation antipsychotics (SGA). These classes have distinct profiles, particularly when it comes to side effects such as extrapyramidal symptoms (EPS) and metabolic syndrome.

A. Second generation antipsychotics have a reduced risk of causing EPS

This statement is correct. Second-generation antipsychotics (SGAs), also known as atypical antipsychotics, generally have a lower risk of causing extrapyramidal symptoms (EPS) compared to first-generation antipsychotics (FGAs). EPS includes symptoms such as tremors, rigidity, and bradykinesia, which are commonly seen with older, first-generation antipsychotics like haloperidol. Second-generation antipsychotics such as clozapine, olanzapine, and risperidone tend to cause fewer motor side effects, making them more favorable in terms of movement disorders.

Why the Other Options Are Incorrect:

B. First generation antipsychotics are more effective for negative symptoms

This statement is incorrect. First-generation antipsychotics (FGAs) are generally more effective at treating positive symptoms of schizophrenia, such as hallucinations and delusions, but are less effective in managing negative symptoms like social withdrawal, anhedonia, and flat affect. Second-generation antipsychotics (SGAs) are typically more effective for treating both positive and negative symptoms of schizophrenia. They work on a broader range of symptoms, making them a preferred option for many patients.

C. There are no differences between these two classes

This statement is incorrect. There are significant differences between first-generation (FGA) and second-generation antipsychotics (SGA). While both classes are used to treat schizophrenia and bipolar disorder, their side effect profiles and mechanisms of action differ. SGAs generally have a lower risk of EPS, but they may be associated with a higher risk of metabolic syndrome (e.g., weight gain, diabetes, dyslipidemia). In contrast, FGAs are more likely to cause EPS but have a lower risk of metabolic side effects.

D. First generation antipsychotics have an increased risk of causing metabolic syndrome

This statement is incorrect. While second-generation antipsychotics (SGAs) are more commonly associated with an increased risk of metabolic syndrome, including weight gain, diabetes, and dyslipidemia, first-generation antipsychotics (FGAs) are generally less likely to cause these metabolic side effects. SGAs such as clozapine and olanzapine are particularly notorious for their metabolic effects, whereas FGAs tend to be more associated with motor-related side effects like EPS.

Correct Answer: D. Are you prescribed medication for angina?

Explanation:

Before prescribing sildenafil (Viagra), the APRN must ensure that the patient does not have contraindications that could cause serious interactions. The most important question to ask is whether the patient is currently prescribed medication for angina, particularly nitrates (e.g., nitroglycerin). Sildenafil works by increasing blood flow to the penis, and it can cause vasodilation. When taken with nitrates, there is a high risk of severe hypotension (dangerously low blood pressure) due to the combined effects on vascular tone. This can lead to fainting, shock, or even death. Therefore, asking about angina medication is critical to prevent these dangerous interactions.

Why the Other Options Are Incorrect:

A. Do you have a family history of asthma?

While asthma is an important medical condition to know about, it is not a direct contraindication for sildenafil. There is no significant interaction between asthma and sildenafil. This question is not as critical for the prescribing of sildenafil as asking about nitrate use or heart conditions.

B. Are you allergic to aspirin?

Aspirin allergies are important to know, but they are not directly relevant to the use of sildenafil. Sildenafil does not contain aspirin, and aspirin allergies typically have more concern with medications like NSAIDs or salicylates, not with sildenafil.

C. Have you ever had an erection lasting more than 30 minutes?

This is a relevant question, as a prolonged erection (priapism) is a known risk of sildenafil. However, this is more of a concern for side effects once the medication is prescribed. It is not a contraindication to prescribing sildenafil; it is a precaution. Asking about erections lasting over 30 minutes would be useful if there are previous issues with priapism, but it is not as critical as assessing for potential drug interactions (e.g., with nitrates).

Correct Answer: C. Fluoroquinolones

Explanation:

C. Fluoroquinolones

Fluoroquinolones, such as ciprofloxacin and levofloxacin, carry an FDA black box warning for the risk of tendonitis and tendon rupture. This serious adverse effect can occur during or even months after treatment and is more common in older adults, patients taking corticosteroids, and those with kidney, heart, or lung transplants. The mechanism is not completely understood, but fluoroquinolones are believed to interfere with collagen synthesis and tendon repair, leading to increased risk of injury, especially in the Achilles tendon.

Why the Other Options Are Incorrect:

A. Aminoglycosides

Aminoglycosides, such as gentamicin and tobramycin, are associated with nephrotoxicity and ototoxicity but do not carry a black box warning for tendon rupture.

B. Tetracyclines

Tetracyclines, like doxycycline, may cause photosensitivity and are contraindicated in children and pregnant women due to effects on bone and teeth, but they are not linked to tendon damage.

D. Cephalosporins

Cephalosporins are generally well tolerated and are not associated with tendonitis or tendon rupture. They do not have this black box warning.

Correct Answer: D. To reduce local bleeding

Explanation:

Epinephrine is often added to local anesthetics like lidocaine to constrict blood vessels at the site of the wound, which reduces local bleeding. By constricting the blood vessels, epinephrine decreases the blood flow to the area, allowing the anesthetic to stay in the tissue longer, prolonging the numbing effect. This also allows for better visualization of the wound during procedures, such as suturing, and minimizes blood loss. Epinephrine's vasoconstrictive effect helps to improve the quality of the procedure and enhance the effectiveness of the anesthetic.

Why the Other Options Are Incorrect:

A. To provide broad spectrum anesthesia to the injury site

Epinephrine does not provide broad spectrum anesthesia. The primary role of lidocaine is to provide local anesthesia by blocking nerve conduction at the injury site. Epinephrine's role is to enhance the effects of lidocaine, particularly by prolonging the anesthetic's duration and reducing bleeding, not by offering a broader spectrum of anesthesia.

B. To treat systemic shock

Epinephrine is sometimes used in treating anaphylactic shock or cardiac arrest due to its vasoconstrictive and heart-stimulating properties, but its use in local anesthesia is not for treating systemic shock. In the case of wound care, it is used to reduce bleeding and prolong anesthesia, not to treat shock.

C. To reduce the risk of refractory hypotension

Epinephrine can increase blood pressure by vasoconstriction and stimulating the heart, but this action is not typically related to refractory hypotension in the context of wound anesthesia. In wound care, epinephrine’s primary role is local to the injury site and is not intended to treat systemic blood pressure issues.

Correct Answer: A. Inhaled corticosteroids (ICS)

Explanation:

Inhaled corticosteroids (ICS) are considered the first-line therapy for the long-term management of asthma. ICS medications work by reducing inflammation in the airways, which helps to prevent asthma symptoms, reduce the frequency of exacerbations, and improve overall lung function. ICS are highly effective in controlling asthma when used regularly, and they address the underlying inflammation that causes asthma symptoms. Common examples of ICS include fluticasone, budesonide, and beclometasone.

Why the Other Options Are Incorrect:

B. Angiotensin receptor - neprilysin inhibitor (ARNI)

Angiotensin receptor-neprilysin inhibitors (ARNI), such as sacubitril/valsartan, are primarily used in the treatment of heart failure and are not used for asthma management. They work by inhibiting the breakdown of certain peptides that regulate blood pressure and fluid balance, which has no direct role in managing asthma.

C. Theophylline

Theophylline is a methylxanthine medication that can be used for asthma management, but it is generally considered a second-line or add-on therapy due to its side effects and narrow therapeutic index. It has fallen out of favor as the preferred treatment for long-term asthma control due to the availability of inhaled corticosteroids (ICS), which are more effective and safer.

D. Long-acting beta agonist (LABA)

Long-acting beta agonists (LABAs), such as salmeterol and formoterol, are used to help control asthma symptoms by relaxing the smooth muscles of the airways. However, LABAs are generally used as an add-on therapy to ICS in asthma management, not as a first-line treatment. Monotherapy with LABAs for asthma is not recommended due to the increased risk of severe asthma exacerbations and death when used without an ICS.

Correct Answer: C. Sildenafil

Explanation:

Doxazosin is an alpha-1 adrenergic blocker commonly prescribed for conditions like benign prostatic hyperplasia (BPH) and hypertension. A common side effect of Doxazosin is orthostatic hypotension, which can cause dizziness and fainting due to a sudden drop in blood pressure upon standing. In some cases, patients might also experience sexual dysfunction, particularly erectile dysfunction. Sildenafil, also known as Viagra, is a phosphodiesterase type 5 (PDE5) inhibitor, which is used to treat erectile dysfunction. If a patient on Doxazosin experiences erectile dysfunction as a side effect, the APRN might consider prescribing Sildenafil to manage this symptom. Sildenafil works by increasing blood flow to the penis, helping the patient achieve and maintain an erection, which can be a concern for some men taking Doxazosin.

Why the Other Options Are Incorrect:

A. Dexamethasone

Dexamethasone is a corticosteroid used to reduce inflammation and treat a variety of conditions, including allergies and autoimmune disorders. It does not address any side effects related to Doxazosin, such as hypotension or erectile dysfunction. Therefore, Dexamethasone would not be used to manage the side effects of Doxazosin

B. Terazosin

Terazosin is another alpha-1 adrenergic blocker similar to Doxazosin. While Terazosin may be used to treat symptoms of BPH or hypertension, it would not be prescribed to address the side effects of Doxazosin. In fact, prescribing another alpha-1 blocker could potentially increase the risk of hypotension, not alleviate it.

D. Albuterol

Albuterol is a beta-2 adrenergic agonist used to treat conditions like asthma or chronic obstructive pulmonary disease (COPD). While it helps with bronchodilation, it does not address the side effects associated with Doxazosin, such as erectile dysfunction or orthostatic hypotension.

Correct Answer: A. Losartan

Explanation:

When treating hypertension in an otherwise healthy patient, angiotensin II receptor blockers (ARBs), such as Losartan, are considered first-line therapy. ARBs are commonly prescribed due to their ability to block the effects of angiotensin II, a potent vasoconstrictor that increases blood pressure. By inhibiting this pathway, Losartan helps to lower blood pressure, promote vasodilation, and reduce the workload on the heart without causing significant side effects commonly associated with other antihypertensive medications.

Why the Other Options Are Incorrect:

B. Metoprolol

Metoprolol, a beta-blocker, is not typically used as a first-line agent for hypertension in an otherwise healthy individual unless there are indications such as heart failure, arrhythmias, or a history of myocardial infarction. Beta-blockers work by blocking the beta-adrenergic receptors in the heart, which slows the heart rate and reduces blood pressure. However, they are not as effective as ARBs or ACE inhibitors for initial treatment of primary hypertension in patients without comorbidities.

C. Furosemide

Furosemide is a loop diuretic, and while it can be used to treat hypertension, especially in patients with fluid overload or heart failure, it is not a first-line agent for primary hypertension in a healthy individual. Diuretics, such as thiazide diuretics, are often used as first-line therapy in some cases of hypertension, but loop diuretics like furosemide are typically reserved for more severe cases or those involving conditions like edema or renal insufficiency

D. Spironolactone

Spironolactone is a potassium-sparing diuretic that works by inhibiting aldosterone, a hormone that promotes sodium and water retention. While it can be effective in treating hypertension and is sometimes used in resistant hypertension, it is not typically first-line therapy. It may be prescribed when a patient has secondary causes of hypertension, such as hyperaldosteronism, or in cases of heart failure or chronic kidney disease.