Tick the antimalarial drug having a gametocidal effect:

Correct Answer: B

Rationale: In the context of antimalarial drugs with gametocidal effects, the correct answer is B) Primaquine. Primaquine is known for its ability to target the sexual forms (gametocytes) of the malaria parasite, thus preventing their transmission to mosquitoes and subsequent spread to other individuals. This action is crucial in malaria control programs to interrupt the life cycle of the parasite. Option A) Mefloquine is not gametocidal but rather acts on the asexual erythrocytic forms of the parasite. It is used for treating and preventing malaria but does not specifically target the gametocytes. Option C) Doxycycline is an antibiotic that is primarily used for treating bacterial infections, including some forms of malaria, but it does not have gametocidal activity. Option D) Sulfonamides are not typically used as primary antimalarial agents. While they may have some activity against the malaria parasite, they are not specifically known for their gametocidal effects. Understanding the gametocidal properties of antimalarial drugs is essential for healthcare professionals, especially nurses, involved in the care and treatment of patients with malaria. By selecting the correct gametocidal drug, like primaquine, nurses can contribute significantly to the prevention of malaria transmission and the overall success of malaria control programs.

Correct Answer: B

Rationale: The correct answer is B. ACE inhibitors are absolutely contraindicated in this woman due to her history of gouty arthritis, as these drugs can worsen the condition. ACE inhibitors can increase levels of uric acid in the blood, leading to gout attacks. Therefore, it is important to avoid ACE inhibitors in patients with a history of gout.

Correct Answer: C

Rationale: Captopril is an ACE inhibitor that works by reducing preload and afterload on the heart, which helps improve symptoms of heart failure. By reducing preload, it decreases the amount of blood returning to the heart, and by reducing afterload, it decreases the resistance the heart has to pump against. This ultimately leads to improved cardiac function and symptom relief in patients with heart failure.

Correct Answer: D

Rationale: In the context of managing angina pectoris, maximal medical therapy aims to address the underlying mechanisms contributing to myocardial ischemia. The correct answer, option D (Isosorbide, atenolol, diltiazem), represents a comprehensive approach targeting different aspects of angina treatment. Isosorbide is a nitrate that dilates coronary arteries, reducing myocardial oxygen demand. Atenolol, a beta-blocker, decreases heart rate and contractility, reducing myocardial workload. Diltiazem, a calcium channel blocker, dilates coronary arteries and reduces myocardial oxygen demand by decreasing contractility and heart rate. Option A (Diltiazem, verapamil, nitroglycerin) includes two calcium channel blockers which, when combined, can lead to excessive vasodilation and negative inotropic effects. Nitroglycerin provides acute relief but is not part of maximal long-term therapy. Option B (Atenolol, isoproterenol, diltiazem) includes an inappropriate use of isoproterenol, a non-selective beta-agonist, which can worsen angina due to increased myocardial oxygen demand. Option C (Verapamil, nifedipine, propranolol) combines two calcium channel blockers with a beta-blocker, which can lead to excessive negative inotropic effects and bradycardia, potentially worsening angina symptoms. Educationally, understanding the rationale behind maximal medical therapy for angina helps students appreciate the multifactorial approach needed to effectively manage this condition. It underscores the importance of balancing oxygen supply and demand in the ischemic heart to alleviate symptoms and improve patient outcomes.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Verapamil. Propranolol, a beta-blocker, should not be prescribed for a patient with angina pectoris who is already receiving Verapamil, a calcium channel blocker. This combination can cause additive negative effects on the heart, such as excessive slowing of the heart rate and decreased cardiac contractility, potentially leading to serious cardiac complications. Nifedipine (Option A), Felodipine (Option B), and Isosorbide mononitrate (Option D) are not contraindicated with Propranolol in the context of treating angina pectoris. Nifedipine and Felodipine are also calcium channel blockers but belong to the dihydropyridine class, which does not have the same negative interactions with beta-blockers like Propranolol. Isosorbide mononitrate is a nitrate that is commonly used in combination with beta-blockers for managing angina. Educationally, understanding the interactions between different classes of cardiovascular drugs is crucial for safe and effective pharmacological management. It is essential for nurses to be aware of potential drug interactions to prevent adverse outcomes and to ensure optimal patient care. In this case, the rationale emphasizes the importance of knowing which drug combinations to avoid in patients with angina pectoris to prevent harmful effects on the cardiovascular system.