Which of the following analgesic drugs would be contraindicated for the patient with occlusive atherosclerotic disease of the legs?

Correct Answer: D

Rationale: The correct answer is D: Morphine. Morphine is contraindicated for patients with occlusive atherosclerotic disease of the legs because it can cause vasodilation, potentially worsening the ischemia in the affected limbs. Acetaminophen (A) is a safe option for pain relief in this patient population. Buspirone and meperidine (B) are not analgesic drugs typically used to treat pain associated with atherosclerotic disease. Zolpidem and morphine (C) are not typically contraindicated in patients with occlusive atherosclerotic disease of the legs.

Correct Answer: A

Rationale: The correct answer is A: Heroin. Heroin is an opioid drug, and withdrawal symptoms typically include intense cravings, restlessness, muscle and bone pain, insomnia, vomiting, and other flu-like symptoms. The man most likely experienced withdrawal due to the physical and psychological dependence associated with heroin use. Cocaine, amphetamines, and LSD do not typically produce physical withdrawal symptoms like heroin.

Correct Answer: A

Rationale: The correct answer is A: Inhibition of transmitter reuptake at noradrenergic synapses. This mechanism of action is consistent with symptoms related to increased noradrenergic activity. By inhibiting reuptake, more neurotransmitter remains in the synaptic cleft, leading to increased stimulation of postsynaptic receptors. Options B, C, and D do not directly relate to the patient's signs and symptoms, which are likely due to excess noradrenergic activity. Option B, activation of opiate receptors, would not explain the symptoms. Option C, activation of serotonergic presynaptic receptors, is not relevant to noradrenergic activity. Option D, stimulation of monoamine release, is less likely as the symptoms are more indicative of increased noradrenaline levels due to reuptake inhibition.

Correct Answer: A

Rationale: The correct answer is A: Amyl nitrite. Amyl nitrite is known to cause methemoglobinemia, which can present as the syndrome described in the patient. Nitrous oxide, propane, and helium do not typically cause methemoglobinemia. Amyl nitrite acts as a vasodilator and can lead to the formation of methemoglobin, reducing the oxygen-carrying capacity of blood. Methemoglobinemia can manifest as cyanosis, headache, dizziness, fatigue, and shortness of breath. Nitrous oxide is an anesthetic gas that does not cause methemoglobinemia. Propane and helium are gases used for various purposes but are not associated with methemoglobinemia. Therefore, based on the patient's symptoms and the mechanism of action of the drugs listed, amyl nitrite is the most likely cause of the syndrome.

Correct Answer: C

Rationale: Beta agonists are commonly prescribed for the management of asthma and COPD due to their bronchodilator effects. These medications work by binding to beta-2 adrenergic receptors in the airway smooth muscle, leading to relaxation and opening of the airways, which helps in relieving bronchoconstriction and improving airflow in respiratory conditions such as asthma and COPD. Option A, hypertension, is not typically treated with beta agonists as they can increase blood pressure due to their effects on beta-1 receptors in the heart. Option B, hyperthyroidism, is not a condition where beta agonists are commonly used. Hyperthyroidism is usually managed with antithyroid medications or radioactive iodine. Option D, diabetes mellitus, is not treated with beta agonists. Diabetes management involves medications that help control blood sugar levels such as insulin, oral hypoglycemic agents, and lifestyle modifications. In an educational context, understanding the appropriate use of beta agonists is crucial for healthcare providers, especially those in primary care or respiratory specialties. Knowing the specific indications for these medications helps in providing optimal care for patients with respiratory conditions like asthma and COPD, ensuring effective symptom management and improved quality of life.