The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-

Correct Answer: D

Rationale: Angiotensin-converting enzyme (ACE) inhibitors, a type of angiotensin inhibitor, may have a serious interaction with nonsteroidal anti-inflammatory drugs (NSAIDs). This interaction can potentially reduce the effectiveness of the ACE inhibitor in lowering blood pressure and may cause kidney damage in susceptible individuals. Therefore, it is crucial for the nurse to be aware of this potential drug interaction and to monitor the patient for any signs of adverse effects when these two drug classes are used together.

Correct Answer: C

Rationale: Higher potency (lower dose for effect) can coexist with lower efficacy (max effect), true, as potency reflects affinity, not ceiling effect. Higher receptor affinity increases potency, true, per receptor theory. Lower potency doesn't mandate lower efficacy; a less potent drug can achieve the same max effect with more dose, making this false. Higher potency with equal efficacy is true (e.g., partial agonists). This pharmacodynamic distinction is vital for drug selection, where efficacy often trumps potency.

Correct Answer: C

Rationale: Drug B, as an inducer of the cytochrome p-450 system, increases the metabolism of Drug A, leading to lower plasma concentrations and reduced therapeutic effects of Drug A. This interaction is a common concern in polypharmacy, where one drug affects the metabolism of another. Monitoring for decreased efficacy of Drug A is essential to ensure the patient receives adequate treatment. Increased adverse effects of Drug B or decreased effects of Drug B are less likely in this scenario.

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: A

Rationale: MAOIs (e.g., phenelzine) block tyramine breakdown, risking hypertensive crisis with foods like cheese, per pharmacology. SSRIs, beta blockers, and benzos lack this interaction-tyramine isn't their concern. MAOIs' dietary restriction is critical, a unique safety point.