Irbesartan (an angiotensin-II receptor antagonist) is contraindicated in:

Correct Answer: C

Rationale: In understanding why Irbesartan is contraindicated in bilateral renal artery stenosis, it's crucial to grasp its mechanism of action. Irbesartan, as an angiotensin-II receptor antagonist, works by blocking the action of angiotensin II, which results in vasodilation and decreased secretion of aldosterone. In bilateral renal artery stenosis, there is already reduced blood flow to both kidneys. By further inhibiting the vasoconstrictive effects of angiotensin II, drugs like Irbesartan can potentially precipitate acute renal failure due to further decreasing renal perfusion. Now, let's assess the other options: A) Left ventricular failure: Angiotensin-II receptor antagonists like Irbesartan are actually indicated in left ventricular failure as they help reduce afterload and preload, thus improving cardiac function. B) Asthma: Irbesartan does not have a direct contraindication in asthma. It is generally well-tolerated in patients with asthma. D) Diabetic nephropathy: Irbesartan is actually indicated in diabetic nephropathy due to its renal protective effects in diabetic patients. Educational context: Understanding the contraindications of cardiovascular pharmacology drugs is essential for safe and effective patient care. It is crucial for healthcare professionals to be aware of drug mechanisms, contraindications, and potential adverse effects to make informed decisions in clinical practice. This knowledge ensures that medications are prescribed appropriately, minimizing risks and optimizing patient outcomes.

Correct Answer: A

Rationale: The correct answer is A) Captopril. Captopril belongs to the class of drugs known as ACE inhibitors, commonly used in the treatment of hypertension and heart failure. One of the common side effects of ACE inhibitors is a dry, irritant cough due to the accumulation of bradykinin in the lungs. This adverse effect is unique to ACE inhibitors and is not typically seen with other antihypertensive drug classes. Option B) Losartan is an angiotensin II receptor blocker (ARB), which does not cause the same cough side effect as ACE inhibitors. Option C) Minoxidil is a direct vasodilator, which may cause side effects like fluid retention and hair growth but not a dry cough. Option D) Propranolol is a beta-blocker, which can cause side effects like fatigue, dizziness, and worsening of asthma/COPD symptoms, but not a dry cough. Educationally, understanding the side effect profile of different drug classes is crucial for healthcare providers to make informed prescribing decisions and manage adverse effects in patients effectively. Recognizing the unique side effect of a dry cough with ACE inhibitors can aid in identifying the culprit drug in a patient presenting with this symptom, as in the case of the diabetic hypertensive patient described in the question.

Correct Answer: A

Rationale: The correct answer is A: History of alcohol use disorder. Alprazolam is a benzodiazepine, which can interact with alcohol, leading to respiratory depression and increased sedation. A history of alcohol use disorder suggests a potential for misuse or overdose. Choices B, C, and D do not directly contraindicate the use of alprazolam for acute anxiety.

Correct Answer: C

Rationale: Correct Answer: C Rationale: 1. The patient is showing signs of lithium toxicity, indicated by symptoms like tremors, diarrhea, vomiting, lethargy, and confusion. 2. Obtaining a stat lithium level is crucial to confirm toxicity levels. 3. Holding lithium pending results prevents further toxicity and guides appropriate treatment adjustments. 4. Administering Cogentin (A) may mask symptoms but does not address the underlying issue of lithium toxicity. 5. Providing reassurance (B) is important but not the priority when the patient is experiencing potential toxicity. 6. Assisting the patient to decrease sodium intake (D) is not the priority as it does not address the immediate need to manage lithium toxicity.

Correct Answer: C

Rationale: The correct answer is C: Zoloft has less adverse side effects than other antidepressants. This is because Zoloft is a selective serotonin reuptake inhibitor (SSRI) known for having a favorable side effect profile compared to other antidepressants. SSRIs are generally well-tolerated and have fewer side effects such as sedation, weight gain, and sexual dysfunction. This makes Zoloft a suitable choice for clients experiencing poor appetite and fatigue. A: Zoloft being less expensive is not a primary consideration when choosing an antidepressant for a client as efficacy and side effect profile are more crucial. B: Zoloft is not extremely sedating, so it may not be the best choice for addressing sleep disturbances. D: While Zoloft may start to improve depressive symptoms relatively quickly, this is not the main influencing factor in this prescriptive choice.