A 63-year-old man with glaucoma maintained on a regimen of topical medications with an exacerbation of his symptoms. He complains of difficulty with his vision in both eyes and has headaches. Which of the following drugs is the most appropriate treatment for this patient?

Correct Answer: C

Rationale: Glaucoma involves elevated intraocular pressure (IOP), and this patient's exacerbation-vision difficulty and headaches-requires effective IOP reduction. Bimatoprost and Latanoprost are prostaglandin analogs, increasing outflow, but may not act fast enough for acute worsening. Pilocarpine , a muscarinic agonist, contracts the ciliary muscle, opening the trabecular meshwork, enhancing aqueous humor outflow, and rapidly lowering IOP-ideal for this scenario. Tetracycline is an antibiotic, irrelevant. Travoprost (E), another prostaglandin, is similar to A and B. Pilocarpine's direct action on outflow makes it most appropriate for urgent IOP control in open-angle or angle-closure glaucoma exacerbation. Its side effects (miosis, brow ache) are tolerable given the need for immediate relief, distinguishing it from slower-acting prostaglandins.

Correct Answer: D

Rationale: The correct technique when administering topical nitroglycerin ointment is to remove the old ointment before applying new ointment. This is important to prevent an accumulation of the medication on the skin, which can lead to an overdose. It is crucial to follow the prescribed instructions for applying topical medications to ensure safe and effective administration.

Correct Answer: B

Rationale: Systemic corticosteroids (e.g., prednisone) for ulcerative colitis cause side effects. Osteoporosis results from reduced bone formation over time. Diabetes stems from glucocorticoid-induced hyperglycemia. Hypertension occurs via sodium retention and vasoconstriction. Mood changes are common due to CNS effects. Weight loss isn't typical; corticosteroids cause weight gain from increased appetite and fat redistribution, making it the exception. This reflects their metabolic impact, requiring monitoring in chronic use.

Correct Answer: B

Rationale: Levonordefrin is a vasoconstrictor that is commonly added to local anesthetic solutions to help reduce bleeding and prolong the anesthetic effect by constricting blood vessels at the injection site. Methylparaben, sodium bisulfite, and sodium pyrosulfite are not vasoconstrictors and do not serve this specific function in local anesthetic solutions.

Correct Answer: A

Rationale: Codeine, an opioid, risks addiction with frequent use. Diarrhea opposes its constipating effect. Euphoria and anxiety are possible but less concerning. Sweating (E) is minor. Addiction potential drives monitoring, given his overuse pattern.