Which of the following drugs would be contraindicated for this patient with cogwheel rigidity and decreased dopamine metabolism in the striatum?

Correct Answer: B

Rationale: Carbidopa is a drug that inhibits the peripheral metabolism of levodopa, allowing more levodopa to reach the brain and be converted to dopamine. In this patient with decreased dopamine metabolism in the striatum, adding carbidopa to the regimen would further enhance the availability of levodopa in the brain, thereby improving symptoms of parkinsonism. The other options do not directly address the issue of decreased dopamine metabolism in the striatum.

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.

Correct Answer: A

Rationale: In this scenario, the most likely drug prescribed for the 48-year-old woman with depressive symptoms would be Amitriptyline (Option A). Amitriptyline is a tricyclic antidepressant commonly used to treat depression, especially in cases where there are associated symptoms of anxiety or insomnia. It works by increasing the levels of neurotransmitters like serotonin and norepinephrine in the brain, which helps improve mood and alleviate depressive symptoms. Trazodone (Option B) is another antidepressant but is typically used more for treating insomnia associated with depression rather than the primary depressive symptoms. Bupropion (Option C) is an antidepressant that is more commonly used for treating atypical depression or smoking cessation rather than typical depressive symptoms. Citalopram (Option D) is a selective serotonin reuptake inhibitor (SSRI) commonly used for treating depression, but in this case, Amitriptyline would be a more appropriate choice based on the symptoms described for the patient. Educationally, understanding the differences between various classes of antidepressants and their specific indications is crucial for nursing practice. It is essential for nurses to be able to differentiate between these medications to provide safe and effective care to patients with depression. Selecting the most appropriate medication based on the patient's symptoms and individual needs is a critical nursing skill that directly impacts patient outcomes.