While teaching a 76-year-old patient about the adverse effects of his medications, the nurse encourages him to keep a journal of the adverse effects he experiences. This intervention is important for the elderly patient because of which alterations in pharmacokinetics?

Correct Answer: C

Rationale: Elderly patients often experience decreased blood flow to the liver due to age-related changes, which can alter drug metabolism and increase the risk of adverse effects. Keeping a journal of adverse effects helps the patient and healthcare provider monitor and manage these effects effectively. Increased renal excretion, alkaline gastric pH, and reduced adipose tissue are less relevant to the need for monitoring adverse effects. Therefore, the nurse's intervention is most important due to altered liver metabolism in elderly patients.

Correct Answer: D

Rationale: Analgesics often act via opioid receptors. Codeine, a weak mu-opioid agonist, relieves mild pain. Tramadol combines mu agonism with serotonin/norepinephrine reuptake inhibition. Dextropropoxyphene is a mu agonist, buprenorphine a partial agonist. Nefopam's analgesia involves monoamine reuptake inhibition and possibly NMDA antagonism, not opioid receptors, distinguishing it. This non-opioid mechanism suits patients intolerant to opioids, offering an alternative in pain management.

Correct Answer: B

Rationale: Carbamazepine carries teratogenic risks (e.g., neural tube defects), making it unsafe in pregnancy. Digoxin is safe, used for fetal arrhythmias or maternal heart conditions, with no major congenital risks, a true statement. Streptomycin causes ototoxicity in the fetus, and methotrexate, a folate antagonist, is highly teratogenic, both unsafe. Propylthiouracil is also safe but not listed here correctly per the key. Digoxin's safety profile in pregnancy makes it a preferred option for cardiac issues, balancing maternal and fetal needs.

Correct Answer: A

Rationale: 5-alpha reductase inhibitors like finasteride for benign prostatic hyperplasia (BPH) require condom use during intercourse because the drug, present in semen, poses a teratogenic risk to a pregnant partner, potentially causing fetal abnormalities. Storing it securely protects children from exposure, as it's hazardous to developing systems. Blood donation is prohibited during and shortly after use due to residual drug in plasma, risking harm to recipients, especially pregnant women. Heavy exercise isn't restricted-activity doesn't alter its efficacy or safety. Condom use is a priority education point, directly addressing reproductive safety, a unique concern tied to its mechanism and pharmacokinetics.

Correct Answer: A

Rationale: Aspirin, an acidic drug, ionizes in the small intestine's alkaline pH, reducing absorption as ionized forms cross membranes less easily than non-ionized. Absorption increases in the stomach's acid pH. Ionization directly affects rate. It absorbs mainly in the stomach and intestine, not beyond. Decreased absorption reflects pH impact, a pharmacokinetic rule.