Many opiates stimulate histamine release by mast cells. The cause of this stimulation remains unclear, but it is considered to be a non-immunological (therefore, not an allergy). There is some speculation that opiates  trigger the release of histamine from mast cells by directly activating G proteins on mast cell surfaces. Opiates are not generally associated with kidney failure, and the most common symptoms in opiate allergy include hives, flushing, hives, low blood pressure, gastrointestinal discomfort (though constipation is typical in most patients and does not indicate allergic reaction), and angioedema.

NSAID's are frequently associated with irritation of the gastric mucosa. This can lead to gastritis, ulcer formation, gastric bleeding, or perforation. NSAID use is not generally associated with weight gain, loss of bone density, muscle spasms, or hypertension. 

The most likely cause of this patient's constipation is the oral iron sulfate that she is taking. Constipation is a very common side effect of oral iron therapy, and for that reason, iron therapy is often given concurrently with a stool softener to relieve constipation. 

The other medications taken, azithromycin, and ibuprofen, each commonly cause some degree of gastrointestinal upset, including but not limited to abdominal pain and diarrhea, but not constipation.

Dietarily, the consumption of green, leafy vegetables is associated with looser, more regular bowel movements, as opposed to constipation. The consumption of greasy, fatty foods is also associated with looser bowel movements, rather than constipation, making it unlikely that her diet is the cause of her constipation.

The correct answer is "Obtain an electrocardiogram (ECG)." 

This question tests your knowledge of the major side effects of the first-generation anti-psychotic medication, haloperidol, also known as Haldol. Some of the major side effects of haloperidol include extrapyramidal symptoms, anticholinergic symptoms, blood pressure changes, and hypersomnolence.

In addition, haloperidol has the potential to prolong the QTc interval on an ECG. QTc prolongation can be particularly dangerous in patients who already have a prolonged QTc interval due to a pre-existing medical condition (e.g. Long QT Syndrome), or medications they are already taking. A prolonged QTc interval has the potential to progress on ECG to more dangerous arrhythmias including torsades de pointes and ventricular fibrillation/tachycardia, which can be fatal. Therefore, it is imperative to check a patient's QTc interval on an ECG prior to administering haloperidol to confirm that they do not already have a prolonged QTc interval.

While this patient's blood glucose is not necessarily going to be normal, that is not something that needs to be emergently checked prior to haloperidol administration. 

There is no indication to obtain a chest x-ray or CT abdomen prior to haloperidol administration. 

It would be inappropriate to contact the authorities to detain this acutely psychotic patient with schizophrenia, as the patient is already in the hospital and in the care of a psychiatric medical team. Further, even though the patient is combative, if necessary, the medical team is allowed to place the patient in restraints without the need for police intervention. There is no evidence that any members of the care team are in acute danger.

The correct answer is nitrates. 

Sildenafil is contraindicated in a patient who is already taking nitrates because nitrates alone can cause a decrease in the patient's blood pressure, and sildenafil can also independently cause a decrease in the patient's blood pressure. When taken together, sildenafil and nitrates can cause a potentially very serious drop in the patient's blood pressure than can cause headache, dizziness, weakness, syncope, and any further consequences of those symptoms. Thus, whenever sildenafil is being considered for a patient, their current medication list should be closely evaluated for any other medications that may decrease their blood pressure.

Neither fish oil, simvastatin, prednisone, nor aspirin are known to decrease blood pressure and therefore would not be contraindications for administering sildenafil to this patient.

The correct answer is "The combined actions of verapamil and sildenafil."

This question tests your understanding of the side effects of multiple medications, as well as how they may interact with one another. In this patient, he complains of headaches and dizziness that are brought on by taking sildenafil, an erectile dysfunction medication. Common side effects of sildenafil include headaches and lightheadedness, as sildenafil can decrease systemic blood pressure since it is a vasodilator. 

The risk of experiencing these side effects from sildenafil is increased in patients who take other medications that can decrease blood pressure. Of the other medications that this patient takes, verapamil, a calcium-channel blocker, is the most likely medication that is known to decrease blood pressure. The combined actions of sildenafil and verapamil (both to decrease blood pressure) best explain the headaches and dizziness that this patient experiences when taking sildenafil in addition to his daily verapamil. 

None of the other choices are correct, as the only choice that contained two medications that each individually would decrease blood pressure to explain the patient's symptoms was the choice containing verapamil and sildenafil.

The correct answer is "You may experience a barky cough when taking lisinopril."

This question tests your knowledge of the side effect profile of lisinopril. A very common side effect associated with lisinopril use is a barky cough. Lisinopril, an ACE inhibitor, has an additional effect of inhibiting the degradation of bradykinin, therefore raising circulating levels of bradykinin. Elevated levels of bradykinin result in bronchoconstriction, which can cause the dry, barky cough that some patients taking lisinopril experience. 

Other side effects of lisinopril include but are not limited to hypotension, headache, dizziness, and syncope.

Lisinopril is not known to cause an elevated risk of renal cell carcinoma, myocardial infarction, stroke, or blindness. 

The correct answer is "Avoid prolonged sun exposure while taking minocycline." 

This question tests your knowledge of a common side effect of the tetracycline antibiotic, minocycline. Minocycline is known to cause phototoxicity as a side effect in some patients, which may increase the risk and/or severity of sunburn in patients taking the medication. As such, patients should be counseled to avoid prolonged sun exposure when taking minocycline, and if they must be exposed to the sun for significant periods of time, to wear sunblock and keep their skin covered as much as possible. 

Other side effects of minocycline include upset stomach, diarrhea, tooth discoloration in young children, and rarely, pseudotumor cerebri (severe headache and visual disturbance due to intracranial hypertension). As such, it would be inappropriate to advise a patient to ignore severe headaches while taking minocycline. 

Apple juice and acetaminophen are not contraindicated in patients taking minocycline.

The correct answer is "Hearing and renal function."

This question tests your knowledge of the significant potential side effects of the aminoglycoside antibiotic, gentamicin. Gentamicin, like most aminoglycosides, carries a risk of ototoxicity and nephrotoxicity. As such, it is very important to assess a patient's hearing function regularly while taking gentamicin, and to follow the patient's BUN/Creatinine, to monitor their renal function while taking gentamicin. In addition, gentamicin dosing is often decided upon via close collaboration with the inpatient pharmacist as they take into account the patient's current dosage and the effect that it has had on the patient's renal function to date.

Gentamicin is not known to significantly influence liver function, hair loss, visual acuity, or hot/cold sensitivity, and therefore these would not be the most important considerations when assessing a patient who is taking gentamicin.

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.