Which of the following drugs was most likely prescribed for the 44-year-old woman with poorly controlled simple partial seizures that was only partially effective with valproic acid therapy?

Correct Answer: D

Rationale: The recently approved drug that acts with a novel mechanism of action, a noncompetitive blockade of AMPA receptors on brain neurons, is Perampanel. Given that the patient had poorly controlled seizures with valproic acid, adding Perampanel would provide a different mechanism of action to improve seizure control.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Nausea, vomiting, and diarrhea. Donepezil, a cholinesterase inhibitor used in Alzheimer's disease, commonly causes gastrointestinal side effects like nausea, vomiting, and diarrhea, especially during the initial days of treatment. Option A) Hypertension, palpitations is incorrect because these symptoms are not typically associated with donepezil use. Option C) Dry mouth, anhidrosis is also incorrect as these are not commonly reported side effects of donepezil. Option D) Drowsiness, lethargy is not a typical side effect of donepezil; in fact, it is more likely to cause insomnia or vivid dreams. Educationally, it is crucial for nursing students to understand the common side effects of medications used in Alzheimer's disease to provide safe and effective care to their patients. Recognizing and managing potential adverse effects promptly can improve patient outcomes and quality of life.

Correct Answer: B

Rationale: The most likely receptors mediating the adverse effect of olanzapine in the 37-year-old woman are GABAergic and muscarinic receptors. Olanzapine, an atypical antipsychotic, can have side effects such as acute psychotic states and aggression, which may be due to its interaction with these receptors. Blocking GABAergic receptors can lead to disinhibition and agitation, while muscarinic receptor blockade can cause cognitive impairment and confusion, both of which could contribute to the patient's acute psychotic state and aggressive behavior.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Amitriptyline. Amitriptyline is a tricyclic antidepressant with sedative properties commonly used to treat depression, anxiety, and neuropathic pain. One of its side effects is anticholinergic toxicity, which can present with symptoms such as dry mouth, blurred vision, urinary retention, constipation, confusion, and delirium. These symptoms align with the patient's presentation. Now, let's analyze why the other options are incorrect: A) Bupropion is an atypical antidepressant that typically does not cause anticholinergic toxicity. It is more commonly associated with side effects like insomnia, headache, and agitation. B) Mirtazapine is another type of antidepressant known for its sedating properties and weight gain side effect. It is less likely to cause anticholinergic toxicity compared to tricyclic antidepressants like Amitriptyline. D) Paroxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression, anxiety disorders, and other conditions. It is not known to cause anticholinergic toxicity to the extent seen with tricyclic antidepressants like Amitriptyline. Educational Context: Understanding the side effects and mechanisms of action of different classes of psychiatric medications is crucial for healthcare professionals, especially when assessing patients presenting with symptoms that may be related to drug toxicity. By knowing the distinctive side effect profiles of drugs like tricyclic antidepressants, healthcare providers can make informed decisions regarding patient care, including appropriate management and potential drug discontinuation or adjustment.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Increased serotonergic activity. The adverse effect experienced by the 54-year-old woman is likely mediated by increased serotonergic activity in the enteric nervous system. Central nervous system stimulants can lead to increased serotonin levels, which can cause adverse effects such as gastrointestinal disturbances. Option A) Blockade of M receptors is incorrect because it refers to muscarinic receptors, which are not typically associated with adverse effects in the enteric nervous system related to CNS stimulants. Option C) Activation of beta receptors is incorrect as beta receptors are more related to the sympathetic nervous system rather than the enteric nervous system. Option D) Increased adrenergic activity is also incorrect because adrenergic activity is associated with the sympathetic nervous system and not typically involved in adverse effects in the enteric nervous system. Educationally, understanding the molecular actions of drugs on the enteric nervous system is crucial for healthcare professionals to anticipate and manage potential adverse effects in patients. This knowledge helps in providing safe and effective care to individuals receiving CNS stimulants and related drugs.