MSN 611 : Clinical Pharm & Intervention for APRNs - NKU

Correct Answer:

D - Steroids may be used as adjunct therapy.

Explanation of the Correct Answer:

In the management of anaphylaxis, corticosteroids such as methylprednisolone or prednisone may be used as adjunct therapy to reduce the risk of biphasic or prolonged reactions. Although steroids do not act quickly enough to treat the acute, life-threatening symptoms of anaphylaxis, they help control inflammation and prevent recurrence of symptoms hours after the initial event. They are not first-line agents but play an important supporting role in comprehensive anaphylaxis management after stabilization with epinephrine.

Why the Other Options Are Incorrect:

A - HTN is a sign of anaphylaxis:

Hypertension (HTN) is not characteristic of anaphylaxis. Instead, anaphylaxis typically causes hypotension due to massive vasodilation and increased vascular permeability, leading to circulatory collapse if untreated.

B - Symptoms can develop over the course of several hours:

Anaphylaxis is a rapid-onset, life-threatening allergic reaction. Symptoms typically begin within minutes to an hour after exposure to the allergen. A several-hour gradual development is more typical of delayed hypersensitivity reactions, not classic anaphylaxis.

C - Antihistamines are adequate treatment:

Antihistamines alone are not sufficient for treating anaphylaxis. They may help alleviate some symptoms such as hives and itching but do not reverse airway obstruction, hypotension, or shock. Epinephrine is the first-line and life-saving treatment for anaphylaxis, with antihistamines serving only as secondary supportive therapy.

Correct Answer:

A - Increased activity of a G-stimulatory protein

Explanation of the Correct Answer:

Fenoldopam is a dopamine D1 receptor agonist. It works by stimulating D1 receptors in the vascular smooth muscle, which increases the activity of a G-stimulatory protein (Gs protein). This leads to the activation of adenylyl cyclase, increasing intracellular cAMP levels. Elevated cAMP activates protein kinase A (PKA), which then leads to vasodilation (particularly in the renal and peripheral vasculature). This results in a decrease in blood pressure, which is beneficial in managing hypertensive emergencies.

Why the Other Options Are Incorrect:

B - Activation of a phospholipase C cascade:

This mechanism is more closely associated with the activation of alpha-1 adrenergic receptors (via Gq proteins), which leads to increased intracellular calcium and vasoconstriction. Fenoldopam, however, acts via Gs proteins and does not involve phospholipase C activation.

C - Inhibition of voltage-gated sodium channels:

This mechanism is typical of antiarrhythmic drugs (like class I antiarrhythmics, such as lidocaine), which work by inhibiting sodium channels to reduce the excitability of cardiac cells. Fenoldopam does not affect sodium channels.

D - Blockade of beta-adrenergic receptors:

Beta-blockers (like metoprolol or propranolol) block beta-adrenergic receptors, reducing heart rate and blood pressure through decreased cardiac output and reduced renin release. Fenoldopam does not block beta-adrenergic receptors; rather, it activates dopamine D1 receptors for vasodilation.

Correct Answer:

C - perineum

Explanation of the Correct Answer:

Prostate-related pain is most commonly felt in the perineum, which is the area between the anus and the scrotum. This is because the prostate is located just below the bladder and in front of the rectum, and its pain is often referred to the perineum due to its proximity to the pelvic floor muscles and nerves. Conditions such as prostatitis or benign prostatic hyperplasia (BPH) can cause discomfort in this region.

Why the Other Options Are Incorrect:

A - Scrotum:

Pain localized in the scrotum is more likely to be related to testicular conditions, such as epididymitis, orchitis, or testicular torsion, rather than prostate-related issues. While prostate conditions can sometimes radiate to nearby areas, scrotal pain is not typically a direct symptom of prostate problems.

B - Sacroiliac area:

The sacroiliac area refers to the region where the sacrum and ilium bones meet, located in the lower back near the pelvis. While pain in this area can be caused by musculoskeletal issues or conditions like sacroiliitis or lumbar spine problems, it is not a common site for prostate-related pain. Prostate pain is more often felt in the pelvic or perineal areas.

D - Glans penis:

Pain in the glans penis is typically associated with conditions like balanitis, urethritis, or penile infections. It is not a typical location for prostate-related pain. Prostate pain, if it radiates, tends to affect the pelvic region or perineum rather than the glans penis.

Correct Answer: D - Low socioeconomic status

Explanation of the Correct Answer: Low socioeconomic status is not considered a direct risk factor for breast cancer. While it may influence access to healthcare and screening, socioeconomic status itself does not have a clear, direct relationship with an increased risk of breast cancer. The other options are well-established risk factors based on medical studies and clinical data.

Why the Other Options Are Incorrect:

A - Personal family history of breast cancer: A personal or family history of breast cancer is a well-established risk factor. If a person has a first-degree relative (mother, sister, or daughter) who has had breast cancer, their risk of developing breast cancer is significantly higher. Genetic factors also play a role in this risk, with mutations in genes such as BRCA1 and BRCA2 contributing to familial cases of breast cancer.

B - Use of hormone replacement therapy: The use of hormone replacement therapy (HRT) in post-menopausal women has been linked to an increased risk of breast cancer. Estrogen and progesterone, commonly used in HRT, can stimulate the growth of hormone receptor-positive breast cancer cells. The longer the duration of HRT use, the higher the associated risk.

C - Post-menopausal obesity: Obesity after menopause is a known risk factor for breast cancer. Post-menopausal women with higher body fat levels have an increased risk because adipose tissue produces estrogen, which can fuel the growth of hormone receptor-positive breast cancers. Additionally, obesity is linked to inflammation and insulin resistance, which may further contribute to cancer risk.

Correct Answer:

B - IV Hydration.

Explanation of the Correct Answer:

Tumor lysis syndrome (TLS) is a potentially life-threatening condition that occurs when a large number of tumor cells are destroyed rapidly, releasing their contents into the bloodstream. This can lead to hyperkalemia, hyperphosphatemia, hypocalcemia, and elevated uric acid levels, which can cause renal failure, arrhythmias, and other complications. IV hydration is a critical management strategy to prevent or treat TLS, as it helps to flush out excess potassium, phosphate, and uric acid through the kidneys, preventing renal damage and electrolyte imbalances.

Why the Other Options Are Incorrect:

A - Dosage reduction:

While dosage reduction may be considered in certain scenarios, it is not the primary strategy for managing tumor lysis syndrome. TLS requires immediate intervention, including hydration and sometimes medications like allopurinol or rasburicase to control uric acid levels, not just reducing the dosage of chemotherapy.

C - Treatment disruption:

Disrupting cancer treatment is not the recommended approach for managing TLS. On the contrary, TLS occurs in response to aggressive tumor cell lysis due to chemotherapy or other cancer treatments. The goal is to manage the consequences of TLS while continuing to treat the underlying leukemia.

D - Drug rotation:

Drug rotation is not relevant to the management of tumor lysis syndrome. TLS is a result of the rapid destruction of cancer cells, and the key management strategies involve supportive care (like hydration) and pharmacologic interventions to control electrolyte imbalances and prevent renal failure.

Correct Answer:

D - bupropion (Wellbutrin)

Explanation of the Correct Answer:

Bupropion (Wellbutrin) is known to cause false positives on urine drug screens, particularly for amphetamines. This is due to the chemical structure of bupropion, which shares similarities with amphetamines and can be mistaken for them on certain types of drug tests. It is a common issue for patients taking bupropion, as the urine drug screen may show a positive result for amphetamine use even if the patient is not using amphetamines. This can occur because bupropion is metabolized into compounds that may cross-react with amphetamine assays.

Why the Other Options Are Incorrect:

A - Metformin (Glucophage):

Metformin is used to treat type 2 diabetes and is not typically associated with causing false positives on urine drug screens. It does not have a chemical structure that would cross-react with common drug screen assays, making it unlikely to produce a false positive result.

B - Alprazolam (Xanax):

Alprazolam (Xanax) is a benzodiazepine, and while it can cause a positive result on a drug screen for benzodiazepines, it does not generally cause false positives for other substances like amphetamines or opiates. Drug tests designed to detect benzodiazepines will accurately identify alprazolam use, without cross-reacting to other drug classes.

C - Loratadine (Claritin):

Loratadine (Claritin) is an antihistamine used for allergies and is not known to cause false positives on urine drug screens. Loratadine does not have the chemical properties to interfere with common drug screen assays, so it is unlikely to cause false positive results for other drugs.

Correct Answer:

D - fever, headache, fatigue, and lymphadenopathy.

Explanation of the Correct Answer:

Rapid HIV testing would be most appropriate for a patient presenting with fever, headache, fatigue, and lymphadenopathy, as these symptoms are classic signs of acute HIV infection, also known as acute retroviral syndrome. This syndrome occurs within 2 to 4 weeks after initial HIV exposure and reflects the body’s response to high viral replication. The symptoms are flu-like and nonspecific, but the presence of lymphadenopathy (swollen lymph nodes) in combination with constitutional symptoms like fever, fatigue, and headache should prompt immediate HIV testing to ensure early diagnosis and initiation of treatment. Rapid HIV tests are valuable in these settings because they provide immediate results and allow for prompt linkage to care.

Why the Other Options Are Incorrect:

A - Painful bowel movements, anal itching, and painful or swollen testicles:

These symptoms are more indicative of conditions such as sexually transmitted infections (e.g., gonorrhea, chlamydia, or herpes) affecting the rectal or genitourinary area. While individuals with these symptoms could potentially also be at risk for HIV (due to associated high-risk behaviors), these specific symptoms do not directly suggest acute HIV infection itself. Therefore, although HIV testing may still be appropriate, rapid HIV testing is not the most immediately indicated action based on these symptoms alone.

B - Painful urination, dyspareunia, and vaginal or penile discharge:

These findings are highly suggestive of common sexually transmitted infections like chlamydia, gonorrhea, or trichomoniasis. Although these infections increase the risk of HIV acquisition, the presence of discharge and painful urination points primarily to localized genitourinary infections rather than systemic viral illness like acute HIV. Thus, HIV testing would be considered, but not as urgently as in a patient presenting with systemic symptoms like fever and lymphadenopathy.

C - Painful urination, lower abdominal pain, and dyspareunia:

These symptoms are more characteristic of pelvic inflammatory disease (PID) in females or possibly a urinary tract infection. While PID and STIs can increase the risk of HIV due to associated mucosal disruption, the symptoms listed here suggest a localized pelvic infection rather than systemic signs of acute HIV viremia. Therefore, while HIV screening may eventually be appropriate, it is not the most immediate diagnostic priority in this scenario.

Correct Answer:

A. Bevacizumab

Explanation of the Correct Answer:

Bevacizumab is a monoclonal antibody that is commonly used in the treatment of metastatic colon cancer. It works by inhibiting vascular endothelial growth factor (VEGF), which plays a key role in tumor angiogenesis (the formation of new blood vessels). By inhibiting VEGF, bevacizumab reduces the blood supply to the tumor, thereby limiting its growth and metastasis. It is typically used in combination with chemotherapy agents such as 5-fluorouracil (5-FU) to treat metastatic colorectal cancer.

Why the Other Options Are Incorrect:

B. Methotrexate

Methotrexate is an antimetabolite that inhibits dihydrofolate reductase and is used in the treatment of various cancers (e.g., leukemia, lymphoma) and autoimmune diseases (e.g., rheumatoid arthritis). However, it is not typically used in the treatment of metastatic colon cancer.

C. Cyclophosphamide

Cyclophosphamide is an alkylating agent used in the treatment of various cancers, such as lymphoma, leukemia, and breast cancer. It is not a first-line treatment for metastatic colon cancer and is not used in this context.

D. Doxorubicin

Doxorubicin is an anthracycline chemotherapy drug that is effective for several cancers, including breast cancer, lymphoma, and sarcoma. However, it is not a standard treatment for metastatic colon cancer and is not used in this context.

Correct Answer:

A. Erythromycin

Explanation of the Correct Answer:

This patient is experiencing symptoms of digoxin toxicity, which can manifest as nausea, vomiting, and visual disturbances, such as a yellow-green tint to vision (xanthopsia). Digoxin toxicity is most commonly seen in patients with predisposing conditions such as congestive heart failure or atrial fibrillation, both of which this patient has.

Erythromycin, an antibiotic, is known to increase the serum levels of digoxin. It does this by inhibiting the P-glycoprotein (P-gp) efflux pump, which is responsible for the clearance of digoxin from cells. This inhibition reduces the renal and hepatic elimination of digoxin, leading to elevated blood levels and an increased risk of toxicity.

Why the Other Options Are Incorrect:

B. Metformin

Metformin is an oral medication used to manage type 2 diabetes. It is not associated with causing nausea, vomiting, or visual disturbances. It can cause gastrointestinal upset but does not lead to the characteristic visual symptoms seen in digoxin toxicity.

C. Warfarin

Warfarin is an anticoagulant used to prevent clotting in patients with atrial fibrillation. Although it requires monitoring of INR levels and can interact with many drugs, it does not cause nausea, vomiting, or visual changes like yellow tinting of vision. There is no indication that warfarin directly causes these symptoms.

D. Pantoprazole

Pantoprazole is a proton pump inhibitor used to treat acid reflux and H. pylori infection. It does not typically affect vision or cause symptoms related to digoxin toxicity. Its side effects are more related to gastrointestinal symptoms or long-term effects on bone health, but not visual disturbances or nausea and vomiting in the context described here.