A male patient was just prescribed an inhaled corticosteroid via MDI for two puffs twice a day. In order to decrease the likelihood of an oral infection, which of the following would you recommend that the patient do?

Correct Answer: D

Rationale: The correct answer is D) Rinse his mouth and gargle with water after inhalation. Rinsing the mouth and gargling with water after using an inhaled corticosteroid helps to decrease the likelihood of developing an oral infection, which is a common side effect of this type of medication. Inhaled corticosteroids can cause oral thrush, a fungal infection in the mouth, and rinsing helps to remove any medication residue that could contribute to this condition. Option A) Receive concurrent bronchodilator therapy is incorrect because while bronchodilators are commonly used in conjunction with inhaled corticosteroids to manage respiratory conditions, it does not directly address the risk of oral infections. Option B) Be prescribed an appropriate antibiotic is incorrect because antibiotics are not typically used prophylactically to prevent oral infections associated with inhaled corticosteroids. Option C) Decrease the frequency to once per day is incorrect because changing the dosing frequency without consulting a healthcare provider can compromise the effectiveness of the medication in managing the respiratory condition for which it was prescribed. Educationally, it is important for healthcare professionals and patients to be aware of the potential side effects of medications and the strategies to mitigate these risks. Proper education on medication administration techniques, such as rinsing the mouth after inhaled corticosteroid use, can help patients achieve optimal therapeutic outcomes while minimizing adverse effects.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Midazolam (Versed). This medication is a benzodiazepine that acts as a sedative and can help synchronize the patient's breathing with the ventilator. Benzodiazepines like midazolam are commonly used in ICU settings to provide sedation and manage agitation in mechanically ventilated patients. Option A) Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and other mental health conditions. It is not indicated for synchronizing breathing with a ventilator. Option C) Dextroamphetamine (Dexedrine) is a stimulant medication used to treat ADHD and narcolepsy. It does not have a role in synchronizing a patient's breathing with a ventilator. Option D) Cisatracurium (Nimbex) is a neuromuscular blocking agent that causes muscle paralysis, including respiratory muscles. While it can be used to facilitate mechanical ventilation by preventing patient-ventilator asynchrony in certain cases, it is not the best choice in this scenario where the patient is already breathing asynchronously. In an educational context, understanding the appropriate use of medications in critical care settings like the ICU is crucial for nursing students and healthcare professionals. Knowing when to use sedatives like midazolam to assist with ventilator synchrony can improve patient outcomes and prevent complications associated with ineffective ventilation support.

Correct Answer: B

Rationale: Ipratropium bromide is a medication commonly used in respiratory conditions such as asthma and COPD. The correct answer is B) Causes bronchodilatation because of its antagonistic effects at the cholinergic M₂/M₃ receptors. Ipratropium bromide is an anticholinergic drug that works by blocking acetylcholine receptors in the airways, leading to bronchodilation. This action helps to relieve bronchospasms and improve airflow in conditions like asthma and COPD. Option A) Is administered intravenously is incorrect because ipratropium bromide is usually administered via inhalation as a metered-dose inhaler or nebulizer, not intravenously. Option C) Has a more rapid onset of bronchodilatation than beta agonists is incorrect because beta agonists like albuterol typically have a faster onset of action compared to ipratropium bromide. Option D) Has a bitter taste is incorrect but is a common side effect of ipratropium bromide when inhaled. This taste is not related to its mechanism of action or effectiveness in causing bronchodilation. Understanding the mechanism of action of respiratory drugs like ipratropium bromide is crucial for healthcare professionals, especially pharmacists and nurses, to ensure safe and effective administration to patients with respiratory conditions. Knowing the correct administration route, onset of action, and common side effects helps in optimizing patient care and medication outcomes.

Correct Answer: C

Rationale: In this case, the correct answer is C) Nitrofurantoin. Pulmonary eosinophilia is a condition characterized by the accumulation of eosinophils in the lungs, often resulting from a hypersensitivity reaction. Nitrofurantoin, commonly used to treat urinary tract infections, is known to cause drug-induced pulmonary eosinophilia as a rare adverse effect. Option A) Methysergide is typically associated with pulmonary fibrosis, not pulmonary eosinophilia. Option B) Aspirin is not a common cause of pulmonary eosinophilia; instead, it is more commonly linked to asthma exacerbations in individuals with aspirin sensitivity. Option D) Carmustine (BCNU) is known for causing pulmonary fibrosis rather than pulmonary eosinophilia. Educationally, understanding the adverse effects of drugs is crucial for healthcare professionals to make informed decisions regarding medication management. Recognizing the specific side effects associated with various medications can aid in early detection, management, and prevention of potentially harmful outcomes for patients. This knowledge is especially important for pharmacology students preparing for exams like the NCLEX, where drug-related questions are common.

Correct Answer: D

Rationale: The correct answer is D) Pindolol. In asthmatics, mast cell degranulation is a key process that leads to the release of inflammatory mediators like histamine, leukotrienes, and prostaglandins, exacerbating asthma symptoms. Pindolol is a non-selective beta-blocker that acts on beta-adrenergic receptors, which are not involved in inhibiting mast cell degranulation. A) Terbutaline is a beta-2 adrenergic agonist that can inhibit mast cell degranulation by activating beta-2 adrenergic receptors, leading to bronchodilation and reducing asthma symptoms. B) Ketotifen is a mast cell stabilizer that inhibits the release of inflammatory mediators from mast cells, thereby preventing mast cell degranulation and reducing asthma symptoms. C) Aminophylline is a methylxanthine derivative that can inhibit mast cell degranulation by increasing intracellular cAMP levels, which in turn suppresses the release of inflammatory mediators from mast cells. Educational Context: Understanding how different drugs affect mast cell degranulation in asthma is crucial for healthcare professionals managing patients with respiratory conditions. It helps in selecting the most appropriate medications to control asthma symptoms effectively. Knowing the mechanisms of action of various drugs can guide clinical decision-making and improve patient outcomes.