Five patients with potential need for intravenous sodium nitroprusside are presented as follows. Which patient would best benefit from such an infusion?

Correct Answer: C

Rationale: The correct answer is patient C, the 55-year-old man with encephalopathy and a blood pressure of 220/160 mm Hg. Sodium nitroprusside is a potent vasodilator used to lower blood pressure in hypertensive emergencies. In this case, the patient's significantly elevated blood pressure puts him at risk for complications such as stroke, myocardial infarction, or renal failure. By lowering his blood pressure with sodium nitroprusside, we can reduce the risk of these serious complications. Patient A, the 21-year-old man with pulmonary edema and a blood pressure of 180/90 mm Hg, does not have severe hypertension that necessitates immediate intervention with sodium nitroprusside. Patient B, the 43-year-old woman with a stroke and a blood pressure of 170/100 mm Hg, also has high blood pressure but not as severe as patient C. Patient D, the 60-year-old man with a myocardial infarction and a blood pressure of 90/60 mm Hg, is hypotensive and would not benefit from a vasodilator like sodium nitroprusside, which could further decrease his blood pressure. In an educational context, understanding the appropriate use of cardiovascular drugs like sodium nitroprusside in different clinical scenarios is crucial for healthcare providers managing patients with hypertensive emergencies. This question highlights the importance of selecting the right medication based on the patient's specific condition and vital signs to optimize outcomes and prevent complications.

Correct Answer: C

Rationale: In this question, the correct answer is option C: Gemfibrozil, which is incorrectly paired with its mechanism of action. Gemfibrozil is a fibric acid derivative that works by activating peroxisome proliferator-activated receptor alpha (PPAR-alpha), leading to an increase in lipoprotein lipase activity, not inhibition. This activation of lipoprotein lipase results in decreased levels of very low-density lipoprotein (VLDL) and triglycerides. Option A, Cholestyramine, is correctly paired with its mechanism of action as it binds bile acids in the intestine, leading to their excretion and thus decreasing cholesterol levels. Option B, Ezetimibe, is also correctly paired with its mechanism of action as it inhibits the NPC1L1 transporter in the intestine, thereby reducing the absorption of dietary cholesterol. Option D, Niacin, is incorrectly paired with its mechanism of action in this context. Niacin works by inhibiting hormone-sensitive lipase in adipose tissue, not lipoprotein lipase. This inhibition leads to reduced free fatty acid mobilization and decreased triglyceride synthesis. In an educational context, understanding the mechanisms of action of cardiovascular drugs is crucial for healthcare professionals to make informed decisions in managing patients with cardiovascular diseases. Knowing the correct mechanisms of action helps in selecting the most appropriate treatment options and predicting possible drug interactions or side effects. Therefore, mastering pharmacology concepts like these ensures safe and effective patient care.

Correct Answer: C

Rationale: The correct answer is C because flashbacks of killing the enemy are indicative of the intrusive symptoms of post-traumatic stress disorder (PTSD), which can be effectively treated with antipsychotic medications like paliperidone. These symptoms are often associated with severe distress and impairment in daily functioning. Choice A (flat affect and anhedonia) typically aligns more with symptoms of depression rather than PTSD. Choice B (persistent anorexia and weight loss) is more related to physical symptoms rather than the core symptoms of PTSD. Choice D (distant and guarded in relationships) may suggest avoidance symptoms of PTSD, but it does not specifically warrant the use of paliperidone. Therefore, choice C is the most appropriate response based on the symptoms indicative of PTSD that would require this medication.

Correct Answer: D

Rationale: The correct answer is D: Fluoxetine (Prozac). The FDA has approved Fluoxetine for the treatment of depression in adolescents aged 8-18. It is one of the few antidepressants approved for pediatric use due to its established safety and efficacy profile. Paroxetine (A) is not recommended for adolescents due to increased risk of suicidal thoughts. Sertraline (B) is FDA-approved for pediatric OCD but not specifically for depression. Citalopram (C) has a black box warning for pediatric use due to potential risks.

Correct Answer: A

Rationale: The correct answer is A because it contains foods low in tyramine. Mashed potatoes, ground beef, corn, green beans, and apple pie are all safe options. Tyramine is found in aged, fermented, and spoiled foods, which are present in the other choices. Avocados, ham, chocolate, sausage, cheese, and banana bread are high in tyramine and should be avoided. Caffeinated coffee contains tyramine as well. A tyramine-restricted diet aims to prevent a hypertensive crisis in individuals taking MAOIs by avoiding foods that can interact with these medications.