A patient is taking aspirin for secondary prevention of myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patient's provider to discuss changing from aspirin to which of the following?

Correct Answer: C

Rationale: The patient is experiencing gastrointestinal upset from taking aspirin. Enteric-coated aspirin would be a suitable alternative in this case because the special coating on the aspirin helps protect the stomach lining and reduces the risk of gastrointestinal irritation. Switching to an enteric-coated aspirin can still provide the antiplatelet benefits needed for secondary prevention of myocardial infarction while minimizing the gastrointestinal side effects. It is important to address the patient's symptoms while ensuring that they continue to receive appropriate treatment for their medical condition.

Correct Answer: C

Rationale: Lorazepam is a benzodiazepine commonly used as a preanesthetic medication due to its anxiolytic and sedative properties. In patients undergoing liver transplantation, where hepatic function is compromised, drugs that rely on liver metabolism could accumulate and cause excessive central nervous system depression. Lorazepam's key advantage lies in its pharmacokinetic profile: it undergoes glucuronidation, a conjugation process that occurs outside the liver, primarily in the kidneys. This extrahepatic metabolism ensures that its clearance is less affected by liver dysfunction, reducing the risk of prolonged or excessive sedation. Unlike other benzodiazepines that depend heavily on hepatic cytochrome P450 enzymes, lorazepam's metabolism is more predictable in such patients, making it a safer choice. Excretion in unchanged form or secretion into the GI tract does not apply, and while it is anxiolytic, it does have CNS depressant effects, ruling out other options. Naloxone reverses opioids, not benzodiazepines.

Correct Answer: D

Rationale: Lithium is commonly used to treat bipolar disorder, where it is effective in reducing the frequency and severity of acute manic episodes. By stabilizing mood, lithium helps in preventing or decreasing the occurrence of manic episodes, which are characterized by elevated, irritable moods, increased energy, and impulsivity. However, it is important to note that lithium does not typically have direct effects on reducing the risk of myocardial infarction, GI ulcers, or respiratory distress.

Correct Answer: C

Rationale: The liver, via portal vein metabolism, drives the first-pass effect, reducing oral drug bioavailability (e.g., morphine) before systemic circulation. Bladder and kidneys excrete, not metabolize first. Stomach degrades some, but liver's enzyme activity dominates. First-pass is liver-centric, shaping dosing.

Correct Answer: C

Rationale: Carbamazepine induces cytochrome P450 (e.g., CYP3A4), accelerating metabolism of drugs like topiramate, tiagabine, and lamotrigine, reducing their levels and complicating dosing. Levetiracetam, excreted renally with minimal hepatic metabolism, avoids P450 interactions, maintaining stable levels when added to carbamazepine. Zonisamide interacts via induction. Levetiracetam's lack of pharmacokinetic interference, per clinical pharmacology, makes it the safest adjunct, enhancing control without altering carbamazepine's efficacy.