A 47-year-old man presents to the ambulatory care center with symptoms of hypoglycemia and is found to have an insulinoma. His medical history is significant for occasional asthma, which he treats using an albuterol inhaler, and an MI for which he takes daily low-dose aspirin. Because he takes aspirin, he is not able to immediately undergo surgery. The physician prescribes diazoxide for therapy until the tumor can be removed. Diazoxide stimulates potassium channels leading to inhibition of insulin release. Which of the following is most likely to occur in this patient as a result of diazoxide therapy?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Hypotension. Diazoxide, by stimulating potassium channels, inhibits insulin release. Insulinoma causes excessive insulin production, leading to hypoglycemia. By inhibiting insulin release, diazoxide helps counteract the hypoglycemic effects in this patient. Option A) Bronchoconstriction is incorrect because diazoxide, by inhibiting insulin release, does not directly cause bronchoconstriction. Option B) Hypertension is incorrect because diazoxide, although it can cause fluid retention leading to edema, is more commonly associated with hypotension due to its vasodilatory effects. Option C) Hypoglycemia is incorrect in this case because diazoxide helps prevent hypoglycemia by inhibiting insulin release in a patient with an insulinoma. Educationally, understanding the pharmacological actions of diazoxide in inhibiting insulin release and its effects on potassium channels is crucial in managing patients with conditions like insulinoma. This knowledge helps in selecting appropriate therapies and anticipating potential side effects like hypotension. It highlights the importance of individualized treatment plans based on the patient's unique medical history and current medications.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Coca-Cola. Ketoconazole, an antifungal medication, is a weakly basic drug that requires an acidic pH for optimal absorption in the stomach. Coca-Cola, being a carbonated beverage containing phosphoric acid, can help in increasing the acidity of the stomach, thus aiding in the absorption of ketoconazole. Option A) Calcium carbonate and Option B) Calcium citrate are not suitable choices for enhancing the absorption of ketoconazole because they are alkaline compounds that could actually decrease the acidity of the stomach, thereby reducing the absorption of the weakly basic ketoconazole. Option C) Cimetidine is an H2 receptor antagonist that reduces gastric acid secretion. While it is used to treat conditions like ulcers and gastroesophageal reflux disease, it would hinder the absorption of ketoconazole due to its acid-reducing effect. Educationally, this question highlights the importance of understanding how the pH of the stomach can impact the absorption of medications, especially weakly basic drugs like ketoconazole. It reinforces the concept of drug interactions with food and beverages, emphasizing the need for healthcare providers to consider these factors when managing patient medications. Understanding such principles is vital for safe and effective pharmacological treatment across different patient populations.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Epinephrine. The lidocaine preparation injected by the physician likely contains epinephrine, which causes the blanching effect by inducing vasoconstriction in the surrounding blood vessels. This vasoconstriction reduces blood flow to the area, leading to the blanching of the tissue. Option B) Levothyroxine is a thyroid hormone replacement medication and is not associated with the blanching effect seen in this case. Option C) Nifedipine is a calcium channel blocker used to treat high blood pressure and angina but is not related to the blanching effect of the tissue. Option D) is incorrect because lidocaine itself does not cause tissue blanching; it is the epinephrine added to the lidocaine preparation that produces this effect. From an educational perspective, understanding the addition of vasoconstrictors like epinephrine to local anesthetics such as lidocaine is crucial for healthcare professionals. This knowledge helps in the management of anesthesia-related complications and ensures patient safety during procedures involving local anesthesia. It also highlights the importance of recognizing the effects of different components in medication preparations to provide effective patient care.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Diarrhea. Bethanechol is a cholinergic agonist that stimulates bowel motility, making it a suitable choice for a patient with neurogenic bowel. Diarrhea is a common adverse effect of bethanechol due to increased gastrointestinal motility. Option A) Bronchodilation is incorrect because bethanechol primarily affects the gastrointestinal system and does not have a significant impact on the respiratory system. Option C) Dry mouth is more commonly associated with anticholinergic medications that have the opposite effect of bethanechol. Bethanechol, being a cholinergic agonist, would not typically cause dry mouth. Option D) Dry skin is not a known adverse effect of bethanechol. Skin-related side effects are not typically associated with this medication. Educationally, understanding the pharmacological effects and common adverse reactions of medications is crucial for healthcare providers to ensure safe and effective patient care. In this case, knowing that bethanechol can lead to diarrhea informs the physician about what to monitor for and how to manage potential side effects when using this medication for neurogenic bowel management in patients with spinal cord injuries.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Pulmonary vasodilation. During inhalational anesthesia, the administration of agents such as sevoflurane or isoflurane leads to pulmonary vasodilation. This effect occurs due to the relaxation of the pulmonary vascular smooth muscle, resulting in increased blood flow to the lungs. Bronchoconstriction (Option A) is not expected with inhalational anesthesia. In fact, these agents typically cause bronchodilation, making it easier for the patient to breathe. A decrease in cerebrovascular resistance (Option B) and a decrease in brain perfusion (Option C) are not typical effects of inhalational anesthesia. In fact, inhalational anesthetics can lead to cerebral vasodilation, potentially increasing cerebral blood flow. Educationally, understanding the effects of inhalational anesthesia on various body systems is crucial for healthcare providers, especially those involved in perioperative care. This knowledge helps in ensuring safe anesthesia administration and optimal patient outcomes during surgical procedures, including pediatric cases like bilateral ear tube placement.