Pharmacology - NCLEX-PN

The chemical type of an antiviral compound is often important in determining its potential mechanisms and, therefore, its utility against specific types of viruses. Interferon is a glycoprotein produced by many types of mammalian cells. It stimulates host mechanisms to prevent viral penetration and also inhibits viral protein synthesis. Idoxuridine, as its name implies, is a pyrimidine, which inhibits viral DNA polymerase. Zidovudine and zalcitabine are also pyrimidines, but they inhibit reverse transcriptase and act as chain terminators. Only acyclovir is a purine that requires viral thymidine kinase to be converted to an active phosphorylated form, which then inhibits viral DNA polymerase.

The most critical safety information a patient must know when initiating beta blocker therapy is that they can not abruptly stop taking their beta blocker, due to the risk of rebound hypertension. A beta blocker would be more likely to cause bradycardia and a depressed effect than anxiety and tachycardia. Beta blockers are not associated with any type of esophagitis and they are not fat soluble, thus it is not crucial to eat a fatty meal with the drug in order to improve absorption.

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.

Carvedilol is a non-selective beta-adrenoceptor and alpha-adrenergic blocker. Lisinopril is an ACE (angiotensin-converting enzyme) inhibitor. Clonidine is an alpha-adrenergic agonist, and amiodarone is a sodium-channel blocker.

Enalapril is an ACE (angiotensin-converting enzyme) inhibitor. One of the most commonly reported side effects of ACE inhibitor use is a chronic dry cough. This is likely due to the medication's inhibition of kininase II (ACE), which results in a buildup of kinins in the respiratory tract.

None of the other medications listed are associated with persistent cough.

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

The proper antidote for overdose of warfarin is vitamin K. Heparin will not reverse the effects of too much warfarin (it would only aggravate the problem). Protamine sulfate is the antidote for overdose of heparin. IV magnesium may be used to antidote digoxin if digibind is unavailable.

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.

Bupropion is an antidepressant used for smoking cessation. None of the other medications listed are used for smoking cessation.

Sertraline, paroxetine, and Citalopra are all selective serotonin re-uptake inhibitors (SSRIs). This class of drug works by blocking serotonin re-uptake in the synapse, thus increasing post-synaptic serotonin stimulation. They are one of the most widely used class of antidepressants in the United States and many parts of the world.

Zolpidem is a short acting nonbenzodiazepine hypnotic. It's actions are similar to benzodiazepine drugs in that it stimulates GABAa receptors at the same location as benzodiazepines. It is used in insomnia for initiating sleep, though it's short half life (3 hours) means it is not generally considered effective for maintaining sleep.

Diazepam is a benzodiazepine. This class of drugs works by potentiating the effects of GABA, our primary inhibitory neurotransmitter, at the GABAa receptor.

All of the answers given are common anticonvulsant medications except risperidone, which is a second generation atypical antipsychotic used in schizophrenia and bipolar disorder.

Lamotrigine carries a black box warning about the following side effects:

• Stevens–Johnson syndrome
• Toxic epidermal necrolysis
• DRESS syndrome (drug reaction/rash with eosinophilia and systemic symptoms)
• Aseptic meningitis

Phenelzine is a monoamine oxidase inhibitor (MAOI). Drugs in this class work by inhibition of monoamine oxidase enzymes, the enzymes responsible for the break down of serotonin, dopamine, and adrenaline.

Bromocriptine is a dopamine agonist used in the treatment for Parkinson's disease, pituitary tumors, and type 2 diabetes.

All of the listed options are side effects of haloperidol, but tardive dyskinesia (TD) is the only one that manifests with involuntary, dyskinetic movements in their face, lips, tongue, trunk, and extremities. TD more frequently occurs among elderly female patients taking long-term dopamine-antagonist medications. Dizziness, weakness, convulsions, seizures, and anxiety are also side effects of haloperidol. Neuroleptic Malignant Syndrome presents with fever and high/unstable blood pressure, muscle cramps and tremors, altered mental status (such as delirium, agitation, or a coma).

The correct answer is "benzodiazepine," as lorazepam, also known as Ativan, is a benzodiazepine drug. Benzodiazepines act by increasing the efficacy of the neurotransmitter, GABA, when it acts upon its particular receptors. They have potent anti-anxiety properties, among other properties, and are frequently given during the initial phase of a panic attack to calm the patient.

On the other hand, the other choices are incorrect. Phenobarbital is an example of a barbiturate. Proproanolol is an example of a beta-blocker. Tamsulosin is an example of an alpha-blocker. Methamphetamine is an example of an amphetamine.

The nurse should instruct a patient on Allopurinol to drink 3000 mL of fluid a day to reduce the risk of kidney stone formation.