A 63-year-old woman is hospitalized in the intensive care unit with overwhelming sepsis. She is on multiple intravenous medications and is now begun on imipenem/cilastatin. The treating physician must be concerned about which of the following side effects of this therapy?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Renal failure. Imipenem/cilastatin is a broad-spectrum antibiotic that can cause nephrotoxicity, especially in patients who are critically ill and receiving multiple medications. The kidneys are responsible for clearing most drugs from the body, and certain antibiotics can be particularly harmful to renal function. In the case of this 63-year-old woman with overwhelming sepsis, her kidneys may already be compromised due to the septic shock, making them more vulnerable to drug-induced damage. Option A) Cardiotoxicity is not typically associated with imipenem/cilastatin therapy. Option B) Gastrointestinal ischemia is not a common side effect of this antibiotic. Option C) Pulmonary fibrosis is not a known side effect of imipenem/cilastatin. Educationally, it is crucial for healthcare professionals to be aware of the potential side effects of medications, especially in critically ill patients who are already at high risk for complications. Understanding the potential nephrotoxic effects of antibiotics like imipenem/cilastatin can help clinicians monitor patients closely, adjust dosages, or consider alternative therapies to prevent harm to the kidneys. Monitoring renal function through lab tests and assessing for signs of renal failure are essential practices in managing patients on potentially nephrotoxic medications, particularly in the intensive care setting.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Enhance mucosal resistance. Misoprostol is a synthetic prostaglandin E1 analog that acts by enhancing mucosal resistance to injury in the gastrointestinal tract. It helps protect the stomach lining from damage caused by nonsteroidal anti-inflammatory drugs (NSAIDs) and other irritants. Option B) Inhibition of gastrin secretion is incorrect because misoprostol does not directly affect gastrin levels. Option C) Inhibition of proton pump secretion is incorrect as misoprostol does not inhibit proton pump activity. Option D) Inhibition of somatostatin release is also incorrect as misoprostol does not affect somatostatin release. Educationally, understanding the mechanism of action of misoprostol is crucial in pharmacology across the lifespan. Misoprostol is commonly used to prevent NSAID-induced peptic ulcers and is especially important in patients with a history of peptic ulcer disease who cannot tolerate H₂ blockers. By enhancing mucosal resistance, misoprostol helps protect the stomach lining and reduce the risk of ulcer formation, making it a valuable therapeutic option in such cases.

Correct Answer: D

Rationale: The best course of treatment for the 69-year-old man with significant xerostomia following treatment for squamous cell carcinoma of the larynx is option D) Pilocarpine. Pilocarpine is a cholinergic agonist that stimulates saliva production, making it an effective treatment for xerostomia. Option A) Bethanechol is also a cholinergic agonist, but it is not as effective for xerostomia as pilocarpine. Carbachol (option B) is primarily used in the eye and is not a common treatment for xerostomia. Option C) suggesting oral liquid intake is not a targeted treatment for xerostomia and may not provide adequate relief for the patient's condition. In the context of pharmacology across the lifespan, understanding the appropriate use of medications like pilocarpine in managing side effects of cancer treatment is crucial. Educating healthcare providers about the mechanism of action and appropriate indications for medications can lead to improved patient outcomes and quality of life. It is essential to consider individual patient characteristics such as age, comorbidities, and treatment history when selecting the most suitable pharmacological interventions.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) 5-HT₃ antagonist. Ondansetron is a selective serotonin 5-HT₃ receptor antagonist that works by blocking serotonin receptors in the chemoreceptor trigger zone and vagal afferents in the gastrointestinal tract. This mechanism helps in reducing nausea and vomiting, making it an effective antiemetic medication. Option B) D₂-receptor antagonist is incorrect because drugs that target D₂ receptors are typically used in the treatment of conditions like schizophrenia and nausea associated with chemotherapy, not in this case of postoperative nausea. Option C) H₂-receptor inhibitor pertains to medications like ranitidine that are used to reduce stomach acid production in conditions like GERD and peptic ulcers, which is unrelated to the mechanism of action of ondansetron. Option D) Serotonin-norepinephrine reuptake inhibitor is a class of antidepressant drugs that work by inhibiting the reuptake of serotonin and norepinephrine in the brain, used in conditions like depression and anxiety, and not in the context of antiemetic treatment. Understanding the mechanism of action of ondansetron is crucial for healthcare professionals, especially in pharmacology across the lifespan. It is essential for managing nausea and vomiting in patients undergoing various treatments, including postoperative care, chemotherapy, and gastroenteritis. This knowledge helps in providing safe and effective care, minimizing adverse effects, and optimizing patient outcomes.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Tardive dyskinesia. Tardive dyskinesia is a long-term adverse effect associated with the prolonged use of antipsychotic medications, especially in individuals with schizophrenia. This condition is characterized by involuntary, repetitive movements of the face and body, such as lip smacking, tongue protrusion, and choreiform movements. Option A) Hypertension is incorrect because it is not a common long-term adverse effect of antipsychotic medications; rather, it is more commonly associated with other factors like lifestyle, genetics, and comorbid conditions. Option B) Myocardial infarction is also incorrect in this context. While antipsychotic medications can have cardiovascular side effects, myocardial infarction is not a common long-term adverse effect of these medications. Option C) Poikilothermia is not a typical long-term adverse effect of antipsychotic medications. Poikilothermia refers to the inability to regulate body temperature, which is not a commonly reported side effect of antipsychotics. Educationally, it is crucial for healthcare providers to be aware of the potential long-term adverse effects of antipsychotic medications, especially in individuals with chronic conditions like schizophrenia. Monitoring for and managing these side effects can improve the overall quality of care for patients with mental health disorders. Regular assessments and communication with patients about medication side effects are essential components of holistic care in pharmacology across the lifespan.