The nurse is caring for a client with a history of hypertension who has experienced uncontrollable non-productive cough related to an ACE inhibitor. Which alternative medication would the nurse anticipate administering?
losartan (Cozaar)
hydralazine HCL (Apresoline)
furosemide (Lasix)
metoprolol (Lopressor)
The Correct Answer is A
A) Losartan (Cozaar): This medication is an angiotensin II receptor blocker (ARB) and is often used as an alternative for patients who experience a cough due to ACE inhibitors. Unlike ACE inhibitors, ARBs do not typically cause a cough because they do not affect bradykinin levels, making losartan an appropriate choice for managing hypertension without the adverse effect of a persistent cough.
B) Hydralazine HCL (Apresoline): While hydralazine is an antihypertensive, it works through a different mechanism (direct vasodilation) and is not a first-line alternative for patients with a history of ACE inhibitor-induced cough. It's generally used in specific situations, such as severe hypertension or heart failure.
C) Furosemide (Lasix): This is a loop diuretic primarily used for conditions like heart failure or edema, rather than for the management of hypertension alone. It does not address the underlying hypertension in the same manner as ACE inhibitors or ARBs.
D) Metoprolol (Lopressor): This is a beta-blocker that can be used for hypertension, but it does not directly address the issue of cough related to ACE inhibitors. Switching to a beta-blocker may not be the best option if the client is specifically seeking to avoid the cough associated with ACE inhibitors.
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Correct Answer is C
Explanation
A) Beta Blockers: While beta blockers can be used to manage some side effects of various medications, they are not typically indicated for managing niacin-induced flushing. Their primary use is in cardiovascular conditions rather than specifically addressing flushing.
B) Calcium Channel Blockers: Calcium channel blockers are primarily used to treat hypertension and certain heart conditions. They do not specifically address the flushing associated with niacin and would not be the expected choice for this side effect.
C) NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be effective in managing niacin-induced flushing. Administering an NSAID, such as ibuprofen, prior to taking niacin can help reduce the flushing response by inhibiting the prostaglandins that contribute to this side effect.
D) Fibric Acid Derivatives: These medications, such as gemfibrozil, are used to lower triglycerides and cholesterol levels, but they do not address the flushing side effect caused by niacin. Their mechanism of action is different and not focused on alleviating flushing symptoms.
Correct Answer is A
Explanation
A) Heparin induced thrombocytopenia (HIT): Argatroban is an indirect thrombin inhibitor specifically used for anticoagulation in patients with HIT. This condition involves a significant drop in platelet counts due to heparin therapy, and argatroban is an appropriate alternative for preventing thrombosis in these patients.
B) Ventricular Dysfunction: While managing anticoagulation may be important in patients with ventricular dysfunction, this condition does not specifically necessitate the use of argatroban. Other anticoagulants may be used based on the clinical situation.
C) Myocardial infarction: Although anticoagulation may be warranted in the setting of a myocardial infarction, argatroban is not specifically indicated for this condition. Other antithrombotic therapies, such as aspirin or heparin, are more commonly used.
D) Hepatotoxicity: Argatroban is metabolized in the liver, so caution is warranted in patients with liver dysfunction. Hepatotoxicity itself would not be a reason to use argatroban; rather, it may require close monitoring or adjustment of dosage.