Pharmaceutical Care

Q: Patients on lithium carbonate therapy should be advised

(a) :  not to restrict their normal dietary salt intake
(b) :  to stop taking the drug if they experi- ence drowsiness
(c) :  to limit water intake
(d) :  to take the medication as a single dose in the morning
(e) :  not to take the drug with food
Answer:  not to restrict their normal dietary salt intake
Explanation:   The rate of excretion of lithium carbonate is generally independent of urine flow and dietary sodium. However, in the presence of sodium deficiency, the excretion of lithium is markedly decreased and toxic levels can accumulate rapidly. Conversely, high sodium intake enhances lithium excretion.

Q: An adult patient who ingested 30 acetaminophen tablets (325 mg/tab) 6 hours ago should be treated with/by

(a) :  EDTA infusion
(b) :  ipecac syrup
(c) :  activated charcoal
(d) :  N-acetylcysteine
(e) :  probenecid
Answer:  N-acetylcysteine
Explanation:   Because the drug was ingested 6 hours ago, the likelihood of removing a large amount of drug from this patient's stomach with ipecac syrup is small. Activated char- coal effectively binds acetaminophen if given soon after ingestion, but its use here is also unlikely to be of value because of the elapsed time. N-acetylcysteine serves as a glutathione substitute that effectively binds the toxin and permits it to be excreted in the urine. N-acetylcysteine is given orally or by lavage tube.

Q: In terms of its major pharmacological effect, atenolol (Tenormin) is most similar to

(a) :  isoproterenol (Isuprel)
(b) :  metaproterenol (Alupent)
(c) :  fenoldopam (Corlopam)
(d) :  albuterol (Ventolin)
(e) :  pindolol (Visken
Answer:  pindolol (Visken
Explanation:   Atenolol (Tenormin) blocks beta-adrener-gic receptors. It differs from pindolol (Visken) primarily in that it has some preferential effect on beta1-adrenoreceptors, which are located chiefly in cardiac muscle. This preferential effect is not absolute and, at higher doses, atenolol may also inhibit betaz-adrenoreceptors, which are located chiefly in bronchial and vascular musculature. Although the mechanism of its antihypertensive effect is not known, the drug is indicated in the management of

Q: Which of the following drugs is generally considered a drug of choice in treating status epilepticus?

(a) :  phenobarbital
(b) :  ethosuximide (Zarontin
(c) :  buspirone (BuSpar)
(d) :  lorazepam (Ativan)
(e) :  phenytoin (Dilantin)
Answer:  lorazepam (Ativan)
Explanation:  When administered parenterally, 10- razepam (Ativan) is a rapidly acting anticonvulsant with fewer tendencies to produce respiratory depression than the barbiturates. It has become a common choice for initial therapy of status epilepticus.

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