All of the following agents are the first-line antimycobacterial drugs EXCEPT:

Correct Answer: D

Rationale: The correct answer is D: Streptomycin. First-line antimycobacterial drugs are those recommended as initial treatment for Mycobacterium tuberculosis infections. Streptomycin is considered a second-line drug due to its potential for serious side effects and development of resistance. Rifampin, Pyrazinamide, and Isoniazid are all first-line drugs supported by extensive clinical evidence and are preferred for initial therapy. Streptomycin is reserved for cases where first-line drugs are contraindicated or ineffective. Therefore, choosing Streptomycin as the correct answer is logical based on its classification as a second-line antimycobacterial drug.

Correct Answer: C

Rationale: The correct answer is C: Furosemide. Furosemide is a loop diuretic commonly used to treat conditions such as edema and hypertension. In this case, the patient likely required a strong diuretic to manage fluid overload, which is best achieved with a loop diuretic like furosemide. Hydrochlorothiazide (A) is a thiazide diuretic, which is less potent than loop diuretics like furosemide. Mannitol (B) is an osmotic diuretic used for conditions such as cerebral edema and not typically included in routine therapeutic regimens. Fenoldopam (D) is a selective dopamine receptor agonist used for acute hypertension but is not commonly included in routine diuretic regimens like furosemide.

Correct Answer: A

Rationale: The correct answer is A: Propranolol. Propranolol is a non-selective beta-blocker that can potentially cause vasoconstriction, increased blood pressure, and decreased oxygen supply to the heart, leading to myocardial infarction (MI) in susceptible individuals. Nitroprusside (B) and Nitroglycerin (C) are vasodilators that help improve blood flow and decrease cardiac workload, making them unlikely to cause MI. Nifedipine (D) is a calcium channel blocker that primarily affects blood vessels and the heart, but it is less likely to cause MI compared to propranolol.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Lithium. Thiazide diuretics, commonly used in the management of heart failure, reduce the excretion of lithium by the kidneys. This can lead to an increase in lithium levels in the body, potentially resulting in lithium toxicity. Therefore, it is crucial to monitor lithium levels closely when a patient on lithium therapy is started on thiazide diuretics. Now, let's discuss why the other options are incorrect: A) Diazepam: Thiazide diuretics do not significantly affect the excretion of diazepam. B) Fluoxetine: Thiazide diuretics do not impact the excretion of fluoxetine. C) Imipramine: Thiazide diuretics do not alter the excretion of imipramine. Educational Context: Understanding drug interactions is essential in clinical practice, especially when managing patients with multiple comorbidities and medications. Pharmacokinetic principles play a vital role in predicting and managing drug interactions. Healthcare professionals need to be aware of how different drugs can affect each other's metabolism, distribution, and elimination to prevent adverse effects and ensure optimal therapeutic outcomes for patients. In this case, recognizing the potential interaction between thiazide diuretics and lithium is crucial for safe and effective patient care.

Correct Answer: C

Rationale: In the case of acute pain of angina pectoris, the most effective treatment would be to administer Sodium nitrate (Option C). Sodium nitrate is a vasodilator that works by dilating the blood vessels, increasing blood flow and oxygen supply to the heart muscle. This helps to relieve the chest pain associated with angina pectoris by reducing the workload on the heart. Option A, Mannitol hexanitrate, is not commonly used in the treatment of angina pectoris. Erythrityl tetranitrate (Option B) and Pentaerythritol tetranitrate (Option D) are also nitrates like Sodium nitrate, but they are not as commonly used or as effective in managing acute angina pain. In an educational context, understanding the mechanism of action of different cardiovascular drugs is crucial for healthcare professionals in making informed decisions about treatment options for patients with cardiovascular conditions. Knowing the specific indications and effectiveness of different medications can help improve patient outcomes and prevent complications.