The home health nurse notes that the elderly patient doubled up on his pain medication, even though the prescribed dose was at a therapeutic level. The patient says, 'If one pill is good, two pills are better.' Which statement best describes the result of the patient's action?

Correct Answer: D

Rationale: Doubling a therapeutic dose exceeds the plateau-efficacy maxes out, but side effects (e.g., sedation) rise with excess, especially in the elderly with slower clearance. Tolerance needs chronic use, not one event. More relief assumes linear gain, not true. Tolerance requiring more is future, not immediate. Side effects reflect pharmacodynamics, a key risk.

Correct Answer: D

Rationale: The patient's uncontrolled hypertension (180/100 mm Hg) despite propranolol, a β-blocker, suggests a drug interaction. Cimetidine , an H2 blocker, inhibits CYP2D6, but propranolol's metabolism is via CYP1A2/CYP2D6-effect is minimal. Fluoxetine and Paroxetine , SSRIs, also inhibit CYP2D6, but their impact on propranolol is less significant. Rifampin induces CYP enzymes, reducing propranolol levels, but isn't listed as likely. Ritonavir (E), a protease inhibitor for AIDS, potently inhibits CYP3A4 and CYP2D6, increasing propranolol levels, yet here it paradoxically fails to control BP, possibly due to complex polypharmacy or adherence issues. Ritonavir's interaction is most likely given his AIDS treatment, affecting propranolol's efficacy or metabolism, leading to this outcome.

Correct Answer: D

Rationale: The correct answer is D) Ion channel. Benzodiazepines act on the GABA-A receptor complex, which is an ion channel receptor. GABA-A receptors are ligand-gated ion channels that allow for the flow of chloride ions into the neuron, leading to hyperpolarization and inhibition of neuronal activity. Benzodiazepines enhance the effect of GABA by increasing the frequency of chloride channel opening, thus producing sedative, anxiolytic, muscle relaxant, and anticonvulsant effects. Option A) G1 receptor and Option B) G5 receptor are not valid receptor types in the context of benzodiazepines. GABA-A receptors are made up of various subunits, but G1 and G5 are not part of the classification in relation to benzodiazepine action. Option C) G4 receptor is also incorrect as it does not correspond to the receptor type affected by benzodiazepines. Understanding the specific receptor types and their interactions with drugs like benzodiazepines is crucial in pharmacology to comprehend the mechanisms of action and potential therapeutic effects or adverse reactions. In an educational context, knowing the receptor types and their respective actions is fundamental for healthcare professionals when prescribing medications, assessing patient responses, and anticipating potential side effects. Understanding the pharmacological basis of drug actions enables safe and effective medication management in clinical practice.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Tolerance. Tolerance refers to the body's adaptation to a drug, resulting in reduced sensitivity to its effects over time. In the case of the woman consuming coffee daily, her body may build up a tolerance to the stimulating effects of caffeine, leading to a decreased response to its alertness-boosting properties. Option A) Decrease in fatigue is incorrect because caffeine typically reduces fatigue and increases alertness, especially in moderate doses. Option B) Decrease in mental alertness is also incorrect as caffeine is known to enhance mental alertness, not decrease it. Option D) Tremors is not the most likely effect for someone with a history of regular coffee consumption at a moderate level. Tremors are more commonly associated with excessive caffeine intake or sensitivity to caffeine rather than moderate consumption leading to tolerance. In an educational context, understanding the concept of tolerance to substances like caffeine is crucial in pharmacology. It highlights the body's ability to adapt to recurring exposure to a drug, leading to a diminished response over time. Educating healthcare professionals about tolerance can help in appropriate dosage adjustments and managing expectations of drug effects in patients who consume substances regularly.

Correct Answer: B

Rationale: Buspirone, a 5HT1A partial agonist, treats GAD by modulating serotonin without sedative or euphoric effects, making it ideal for patients with substance abuse histories like secobarbital (a barbiturate). It lacks abuse potential, unlike benzodiazepines, and doesn't cause dependence, aligning with the patient's needs. Bupropion, an NE/DA reuptake inhibitor, targets depression and smoking cessation, not GAD, and has stimulant-like risks. Baclofen, a GABA_B agonist, manages spasticity, not anxiety, and has some abuse potential. Buprenorphine, an opioid partial agonist, treats addiction but not GAD and carries dependence risk. Phenobarbital, a barbiturate, mirrors the patient's abuse history and is contraindicated. Buspirone's efficacy in GAD, non-addictive nature, and safety in this context make it the optimal choice.