The correct answer is "If you notice a skin rash, please call your physician immediately, and if nobody answers, go to the nearest emergency department."

This question tests your knowledge of the side effects of trimethoprim/sulfamethoxazole, a sulfa antibiotic. This medication has a number of uses, and is frequently used to treat urinary tract infections, as in this patient. A rare, but potentially fatal side effect of trimethoprim/sulfamethoxazole is a severe skin rash called Stevens-Johnson Syndrome. This rash results in death of the cells of the epidermal skin layer, and results in their separation from the dermal skin layer. It occurs for a handful of reasons, but most commonly is a hypersensitivity reaction in the skin and mucus membranes to medications, such as trimethoprim/sulfamethoxazole or anti-epileptics. It is a true medical emergency. Thus, if any patient taking trimethoprim/sulfamethoxazole experiences a new skin rash, they should call their prescribing physician immediately, and if no one answers, they should proceed to the nearest emergency room.

Neither fish oil, nor banana consumption are contraindicated in patients taking trimethoprim/sulfamethoxazole.

Trimethoprim/sulfamethoxazole does not typically have any appreciable effects on one's ability to operate heavy machinery, motor vehicles, or play contact sports.

The correct answer is "constipation," as constipation is a very common side effect associated with use of opioid medications, such as oxycodone, especially in patients who have not been frequently treated with opioids in the past. As such, patients are often advised ahead of time about the possibility this side effect and may be started concurrently on stool softeners and colonic motility agents, such as senna and/or docusate.

Blindness, tinnitus (ringing in the ears), headache, and serotonin syndrome all are not known to be associated with use of opioid medications, like oxycodone.

The correct answer is "pruritis." Pruritis, or itching, is a fairly common side effect of opioid medication use, and hydromorphone, also known as Dilaudid, is a potent opioid. As such, patients should be advised of this potential side effect prior to initiation of therapy, and should be advised to inform the nursing or medical care team if they experience pruritis, as dosing can be adjusted, and/or additional medications may be added to control the itchiness. 

Neither hair loss, foot pain, pharyngitis, nor diarrhea are side effects known to be associated with opioid use.

The correct answer is "diarrhea." Diarrhea is a common side effect associated with antibiotic use, including cephalexin. This diarrhea is typically self-limited and resolves within the first day or two of administration. Sometimes patients are advised to take a probiotic or consume yogurt when starting a new antibiotic if they experienced diarrhea when starting antibiotics in the past. 

Neither headaches, hair loss, pharyngitis, nor necrotizing skin rash are known common side effects of cephalexin use.

The correct answer is "pregnancy." Patients initiating isotretinoin therapy should all be strictly advised to avoid becoming pregnant, and must absolutely not be started on isotretinoin therapy if they are actively pregnant. Isotretinoin is a potent teratogenic agent, and could cause devastating effects to a developing fetus, including but not limited to termination of the pregnancy. Any female patient who is going to start isotretinoin therapy must be tested for pregnancy immediately prior to therapy and repeatedly throughout treatment. 

There is no known significant interaction between isotretinoin and NSAID use. Likewise, there is no reason why a patient on isotretinoin must avoid bananas, grains, or juices.

All of these are possible side effects of calcium channel blockers, but the most common side effect is edema. Calcium channel blockers decrease blood pressure by hindering the influx of calcium into myocardial cells. They may also increase the diameter of blood vessels, which always results in decreased blood pressure.

Hydrochlorothiazide is a thiazide diuretic, used primarily in the treatment of hypertension and edema.

Losartan is an angiotensin receptor blocker (ARB). This class of drugs lowers blood pressure by blocking the conversion of angiotensin I to angiotensin II and is useful for patients who cannot tolerate ACE (angiotensin-converting enzyme) inhibitors' adverse effects.

Diltiazem is an example of a calcium channel blocker. This class of drugs reduces blood pressure by relaxing smooth muscles in the walls of arteries, leading to vasodilation and decreased peripheral resistance.

Beta blockers act by blocking response to beta-adrenergic stimulation. In that way they are beta-adrenergic antagonists, rather than agonists. ACE (angiotensin-converting enzyme) inhibitors, not beta blockers, block the production of angiotensin II, but both act to decrease blood pressure. Beta blockers have nothing to do with beta cells of the pancreatic islets, which secrete insulin.