Which of the following adverse effects would be most likely to occur in a patient with exertional angina who is started on sublingual nitroglycerin and isosorbide mononitrate?

Correct Answer: B

Rationale: The correct answer is B: Postural hypotension. Nitroglycerin and isosorbide mononitrate are vasodilators that can cause a sudden drop in blood pressure when standing up, leading to postural hypotension. This is especially risky in patients with exertional angina, as it can exacerbate symptoms. A: Cough and wheezing are not common side effects of nitroglycerin or isosorbide mononitrate. C: Reflex bradycardia is unlikely as these medications primarily affect blood vessels, not the heart rate. D: Methemoglobinemia is a rare side effect associated with certain medications but is not commonly seen with nitroglycerin or isosorbide mononitrate.

Correct Answer: A

Rationale: The correct answer is A) Alprostadil. Alprostadil is a medication used in the treatment of male impotence (erectile dysfunction) by directly activating prostaglandin E1 receptors, leading to vasodilation and increased blood flow to the penis, thereby facilitating an erection. Option B) Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used primarily as an antidepressant and is not indicated for the treatment of male impotence. Option C) Mifepristone is a medication used for medical abortion in combination with misoprostol and is not used for male impotence. Option D) Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor used for the treatment of erectile dysfunction by enhancing the effects of nitric oxide, leading to vasodilation and improved blood flow to the penis. While both Alprostadil and Sildenafil are used in erectile dysfunction, the specific mechanism of action described in the question points to Alprostadil as the correct answer. Understanding the mechanisms of action of different drugs used in the treatment of male impotence is crucial for healthcare professionals to make informed decisions regarding the selection of appropriate medications for patients. This knowledge helps in providing effective and tailored treatment options based on individual patient needs and medical history.

Correct Answer: C

Rationale: Quinidine is a Class I antiarrhythmic drug that primarily works by blocking sodium channels in cardiac tissues. The correct answer to the question is C) Auricular fibrillation. Quinidine can cause paradoxical tachycardia in a patient with auricular fibrillation because it can lead to an increase in the ventricular rate by blocking the atrioventricular node, thereby allowing more rapid conduction of atrial impulses to the ventricles. Option A) Sick sinus syndrome is incorrect because quinidine is more likely to exacerbate bradycardia in patients with this condition rather than cause paradoxical tachycardia. Option B) Auricular extrasystoles is incorrect because quinidine is used to treat this condition rather than cause paradoxical tachycardia in patients with it. Option D) Ventricular extrasystoles is incorrect because quinidine typically does not cause paradoxical tachycardia in patients with this condition. Understanding the effects of quinidine on different cardiac conditions is crucial for healthcare professionals, especially pharmacists and physicians, to ensure safe and effective treatment of patients with arrhythmias. It is essential to recognize the potential paradoxical responses to antiarrhythmic drugs to avoid worsening the patient's condition.

Correct Answer: C

Rationale: In pharmacology, understanding the route of administration of a drug is crucial for its efficacy and safety. In the case of glyceryl trinitrate, the correct route is sublingual (Option C). This is because glyceryl trinitrate is a vasodilator used to treat angina, and the sublingual route allows for rapid absorption through the mucous membranes under the tongue, ensuring quick onset of action to relieve angina symptoms. The other options are incorrect for the following reasons: - Oral route (Option A): Glyceryl trinitrate would undergo extensive first-pass metabolism in the liver if taken orally, reducing its effectiveness. - Intravenous route (Option B): Intravenous administration would be too rapid and could lead to sudden drops in blood pressure. - Subcutaneous route (Option D): Subcutaneous administration would be slower compared to the sublingual route, delaying the onset of action in a situation where rapid relief is needed for angina. Educationally, this question highlights the importance of understanding drug administration routes in pharmacology. It emphasizes the need for healthcare professionals to select the appropriate route based on the drug's properties and the desired therapeutic effect. Understanding these principles is essential for safe and effective medication management in clinical practice.

Correct Answer: C

Rationale: In pharmacology, the selection of a cardio-selective beta blocker is crucial based on the desired therapeutic outcomes and potential adverse effects. The correct answer is C) The client has asthma that would be exacerbated by a non-cardio-selective beta blocker. Asthma is a condition characterized by bronchoconstriction and airway inflammation. Non-cardio-selective beta blockers can lead to bronchoconstriction by blocking beta-2 receptors in the lungs, worsening asthma symptoms. Cardio-selective beta blockers primarily target beta-1 receptors in the heart, minimizing the effect on beta-2 receptors in the lungs and reducing the risk of bronchoconstriction in asthmatic patients. Option A is incorrect because the reason for ordering a cardio-selective beta blocker is not related to blockage of beta receptors in blood vessels. Option B is incorrect as hypotension is a potential side effect of all beta blockers, not just non-cardio-selective ones. Option D is incorrect as hypoglycemia is more commonly associated with non-selective beta blockers due to their interference with glucose metabolism. Educationally, understanding the rationale behind selecting specific beta blockers based on their receptor selectivity is crucial for optimizing patient care and minimizing adverse effects, especially in patients with comorbid conditions like asthma. Healthcare providers need to consider individual patient characteristics and tailor pharmacological treatment to ensure safe and effective therapy.