Which of the following receptors most likely mediated the adverse effects of imipramine in the 54-year-old woman?

Correct Answer: C

Rationale: In this scenario, the correct answer is C) M cholinergic receptors. Imipramine is a tricyclic antidepressant that exerts its pharmacological effects by inhibiting the reuptake of norepinephrine and serotonin. However, it also has anticholinergic properties, leading to adverse effects commonly associated with muscarinic receptor blockade. Beta-1 adrenergic receptors (option A) are not primarily involved in the adverse effects of imipramine. While imipramine can cause tachycardia, it is more related to its anticholinergic effects rather than beta-1 adrenergic stimulation. 5-HT serotonergic receptors (option B) are targeted by selective serotonin reuptake inhibitors (SSRIs) rather than tricyclic antidepressants like imipramine. Imipramine's adverse effects are not primarily mediated through 5-HT receptors. Alpha-1 adrenergic receptors (option D) are not the main mediators of imipramine's adverse effects. While imipramine can cause orthostatic hypotension due to alpha-1 adrenergic blockade, it is not the key mechanism for most adverse effects seen with this drug. Educationally, understanding the pharmacological actions of drugs like imipramine is crucial for nurses and healthcare professionals to anticipate and manage potential adverse effects in patients. Recognizing the role of different receptors in drug actions helps in safe medication administration and patient care.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Chlorpromazine. Chlorpromazine is a typical antipsychotic medication that acts by blocking dopamine receptors in the brain. One of the common side effects of chlorpromazine is extrapyramidal symptoms, such as muscle stiffness, tremors, and spasms. These symptoms are indicative of drug-induced movement disorders, known as extrapyramidal side effects (EPS). Hence, chlorpromazine is most likely to have caused the reported symptoms in the patient. Now, let's discuss why the other options are incorrect: A) Lithium: Lithium is primarily used to treat mood disorders like bipolar disorder. It does not typically cause extrapyramidal symptoms. B) Amitriptyline: Amitriptyline is a tricyclic antidepressant that does not commonly cause extrapyramidal symptoms. C) Fluoxetine: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used for treating depression and anxiety disorders. It is not associated with extrapyramidal symptoms like those seen in the patient. In an educational context, understanding the side effect profiles of different drug classes is crucial for safe medication administration and patient care. Nurses and healthcare professionals need to be able to recognize and attribute symptoms to specific medications to ensure timely interventions and prevent complications. This knowledge also helps in monitoring patients for adverse effects and adjusting treatment plans accordingly.

Correct Answer: C

Rationale: In the context of treating major depressive disorder, the most appropriate drug among the options provided is Bupropion (option C). Bupropion is an atypical antidepressant that works by selectively inhibiting the reuptake of dopamine and norepinephrine, which are neurotransmitters associated with mood regulation. It is particularly effective for patients with major depressive disorder who may not respond well to other classes of antidepressants. Amitriptyline (option A) is a tricyclic antidepressant that is more commonly used for conditions like neuropathic pain and insomnia rather than as a first-line treatment for major depressive disorder. Clonidine (option B) is primarily used to treat hypertension and ADHD, not major depressive disorder. Mirtazapine (option D) is a tetracyclic antidepressant that is more commonly used for treating depression with associated sleep disturbances and appetite changes, but it is not typically the first choice for major depressive disorder. Educationally, understanding the mechanisms of action and indications of different classes of antidepressants is crucial for nursing students preparing for the NCLEX exam. It is important for students to be able to differentiate between these drugs to make appropriate clinical decisions based on individual patient needs and characteristics. This question assesses the student's knowledge of antidepressant pharmacology and their ability to apply that knowledge in a clinical scenario.

Correct Answer: A

Rationale: Amitriptyline is a tricyclic antidepressant that can interact with metoclopramide, leading to increased risk of side effects such as confusion, hallucinations, and irregular heart rhythm. This interaction is well-documented in medical literature and is a known pharmacodynamic interaction between the two drugs.

Correct Answer: C

Rationale: Hydrochlorothiazide is a diuretic that can lead to electrolyte imbalances and kidney issues, including anuria (inability to urinate). It is important to monitor patients on hydrochlorothiazide for signs of kidney dysfunction, especially in those with a history of hypertension and other comorbid conditions.