A 69-year-old man with exercise-induced angina presents to his primary care physician for follow-up. The angina is worsening and is now present at rest. The patient is not taking any medications. Isosorbide dinitrate sublingual is prescribed for the patient. Which of the following interactions must the physician warn this patient about?

Correct Answer: C

Rationale: Isosorbide dinitrate, a nitrate, treats angina by dilating vessels, but its interaction with sildenafil causes severe hypotension. Both enhance cGMP, leading to profound vasodilation, a life-threatening risk. Cold extremities or hot extremities may occur as minor effects but aren't primary concerns. Tinnitus and vertigo (E) aren't linked. Given his age and potential for erectile dysfunction treatment, warning about sildenafil is critical. Nitrates' rapid action relieves rest angina, but this interaction demands patient education to prevent catastrophic blood pressure drops, distinguishing it from less severe side effects.

Correct Answer: D

Rationale: Warfarin overdose (INR 7.2, bleeding) needs reversal. Vitamin K -restores clotting factors long-term. Fresh frozen plasma acts faster but isn't sole therapy. Platelets don't reverse. Protamine is for heparin. Whole blood (E) isn't specific. Vitamin K is standard.

Correct Answer: D

Rationale: High-density lipoproteins (HDLs) are often referred to as the "good cholesterol" because they help remove excess cholesterol from the bloodstream back to the liver for processing and excretion. Higher levels of HDL cholesterol are associated with a reduced risk of coronary artery disease and other cardiovascular diseases. A higher HDL level is considered beneficial for heart health, while lower levels are associated with an increased risk of heart disease. Monitoring HDL cholesterol levels is important in the management of coronary artery disease and assessing cardiovascular risk.

Correct Answer: D

Rationale: Dextromethorphan (DM), a cough suppressant, can cause dizziness, hallucinations, and confusion, especially with alcohol, which amplifies CNS depression . Dialysis isn't standard for DM overdose; it's not an opioid , though it acts centrally; and addiction isn't the acute issue. The nurse considers dizziness as a key adverse effect, worsened by beer, guiding a response to seek medical help.

Correct Answer: B

Rationale: The patient's hemoglobin level of 12.8 mg/dL is within the target range for erythropoietin therapy, which is typically 10-12 g/dL. The nurse should continue monitoring the patient and ensure that the hemoglobin does not exceed 12 g/dL, as higher levels can increase the risk of thromboembolic events. Administering additional erythropoietin is unnecessary and potentially harmful. Stopping the medication abruptly is not indicated unless directed by the healthcare provider. Colony-stimulating factors are used to increase white blood cell counts, not hemoglobin levels.

Correct Answer: D

Rationale: Analgesics often act via opioid receptors. Codeine, a weak mu-opioid agonist, relieves mild pain. Tramadol combines mu agonism with serotonin/norepinephrine reuptake inhibition. Dextropropoxyphene is a mu agonist, buprenorphine a partial agonist. Nefopam's analgesia involves monoamine reuptake inhibition and possibly NMDA antagonism, not opioid receptors, distinguishing it. This non-opioid mechanism suits patients intolerant to opioids, offering an alternative in pain management.

Correct Answer: C

Rationale: Isosorbide dinitrate, a nitrate, treats angina by dilating vessels, but its interaction with sildenafil causes severe hypotension. Both enhance cGMP, leading to profound vasodilation, a life-threatening risk. Cold extremities or hot extremities may occur as minor effects but aren't primary concerns. Tinnitus and vertigo (E) aren't linked. Given his age and potential for erectile dysfunction treatment, warning about sildenafil is critical. Nitrates' rapid action relieves rest angina, but this interaction demands patient education to prevent catastrophic blood pressure drops, distinguishing it from less severe side effects.

Correct Answer: B

Rationale: Furosemide belongs to the sulfonamide drug class. Physicians commonly prescribe furosemide for its diuretic effects in conditions like heart failure, hypertension, and edema. It is crucial for the nurse to assess the patient for allergies to sulfonamides before administering furosemide due to the potential for cross-reactivity between these drugs. Allergies to sulfonamides can lead to severe reactions, such as skin rashes, itching, and in rare cases, anaphylaxis. By identifying any potential allergies, the nurse can prevent adverse reactions and ensure patient safety.

Correct Answer: C

Rationale: Republic Act 6675, known as the Generics Act of 1988, is the act in the Philippines that promotes and ensures the production of an adequate supply, distribution, use, and acceptance of drugs identified by their generic names. The main goal of this act is to make quality generic medicines more accessible and affordable to the public. By encouraging the use of generic drugs, R.A 6675 aims to provide Filipinos with more affordable options for their healthcare needs while maintaining the quality and effectiveness of the medications. This act helps promote transparency in drug pricing and provides regulations to ensure the safety and efficacy of generic medicines in the country.