Which drug is the most effective for lowering low density lipoprotein (LDL) cholesterol?

Correct Answer: A

Rationale: The correct answer is A: Atorvastatin. Atorvastatin belongs to a class of drugs known as statins, which are highly effective in lowering LDL cholesterol levels by inhibiting the enzyme responsible for cholesterol production in the liver. This mechanism of action has been proven to significantly reduce LDL cholesterol levels in the blood. In contrast, choice B (Gemfibrozil) primarily targets triglycerides and has limited impact on LDL cholesterol. Choice C (Ezetimibe) works by blocking cholesterol absorption in the intestines but is not as potent as statins in lowering LDL cholesterol. Choice D (Cholestyramine) is a bile acid sequestrant that binds to bile acids in the intestines, but it is less effective than statins in lowering LDL cholesterol. Overall, Atorvastatin is the most effective choice for reducing LDL cholesterol levels due to its potent mechanism of action.

Correct Answer: B

Rationale: Step 1: Drugs with a narrow therapeutic index have a small range between the minimum effective dose and the minimum toxic dose. Step 2: Genetic variants affecting drug metabolism can lead to small increases or decreases in drug levels. Step 3: Small increases can cause toxicity, while small decreases can lead to therapeutic failure. Step 4: Therefore, statement B is true as it correctly describes the impact of genetic variants on drug metabolism for drugs with a narrow therapeutic index. Summary: Statement A is incorrect as not all statements are true. Statement C is incorrect as drugs like warfarin are indeed affected by CYP2C9. Statement D is incorrect as drugs with a high therapeutic index are less affected by altered metabolism compared to drugs with a narrow therapeutic index.

Correct Answer: A

Rationale: The correct answer is A: Drug interactions. Elderly patients are at higher risk for drug interactions due to age-related changes in metabolism and multiple medications. This can lead to adverse effects, reduced efficacy, or toxicity. It is the highest priority as it directly impacts patient safety. Summary of other choices: B: Cost of medications - While important, it is not as critical as drug interactions for patient safety. C: Schedule of medications - Important for adherence but not as urgent as addressing potential drug interactions. D: Nonadherence to drug regimen - Also important, but drug interactions pose a more immediate risk to the patient's health.

Correct Answer: A

Rationale: The correct answer is A: Diuretics. Diuretics are used to decrease preload in heart failure patients by promoting diuresis, reducing fluid volume, and subsequently decreasing the pressure within the heart chambers. This helps to alleviate symptoms of fluid overload and reduce cardiac workload. Corticosteroids (B) are not typically used for preload reduction in heart failure. Beta blockers (C) and calcium channel blockers (D) primarily work by reducing afterload and improving cardiac function, rather than directly targeting preload reduction.

Correct Answer: D

Rationale: The correct answer is D: Prescribe amoxicillin/clavulanate and refer the child to an otolaryngologist. Rationale: 1. Amoxicillin/clavulanate is a recommended first-line antibiotic for recurrent otitis media due to its broad spectrum coverage. 2. Referring the child to an otolaryngologist is necessary for further evaluation and management of recurrent ear infections, as this child has had multiple episodes in a year. Summary of other choices: A: Prescribing both high dose amoxicillin and the influenza vaccine is not the best option as the child already has recurrent ear infections and needs a more comprehensive approach. B: Beginning prophylactic antibiotic therapy with trimethoprim/sulfamethoxazole is not recommended as a first-line treatment for recurrent otitis media. C: Prescribing ceftriaxone IV with benzocaine ear drops is not the optimal choice for managing recurrent ear infections in a 2-year-old.