A nurse is caring for a client who is receiving midazolam during a colonoscopy.
The client's blood pressure decreases from 122/84 mm Hg to 85/50 mm Hg. Which of the following medications should the nurse expect the provider to prescribe for the client?

Choice A rationale

An elevated troponin level indicates myocardial injury or infarction. While severe acetaminophen toxicity can rarely lead to cardiac dysfunction, it is not a primary or common finding. The main organ affected is the liver due to the formation of toxic metabolites.

Choice B rationale

Hyperglycemia is not a typical finding in acetaminophen toxicity. Liver damage can impair glucose regulation, but the immediate and common metabolic derangements are usually related to liver enzyme elevation and acid-base imbalances, not primary glucose elevation.

Choice C rationale

Increased alanine aminotransferase (ALT) level is a critical indicator of hepatotoxicity, the primary concern in acetaminophen overdose. N-acetyl-p-benzoquinone imine (NAPQI), a toxic metabolite, depletes glutathione, leading to hepatocellular necrosis and leakage of intracellular enzymes like ALT (normal range 7–55 U/L).

Choice D rationale

Abdominal discomfort is a common finding in acetaminophen toxicity, particularly as liver damage progresses. This discomfort, often described as right upper quadrant pain, results from hepatocellular injury and inflammation, potentially accompanied by hepatic swelling.

Choice E rationale

Diaphoresis, or excessive sweating, is an early and non-specific symptom of acute acetaminophen overdose. It often accompanies other initial gastrointestinal symptoms like nausea and vomiting, occurring as the body attempts to excrete the drug and in response to initial metabolic stress.

Choice A rationale

Gastrointestinal reflux, or GERD, is a condition where stomach acid flows back into the esophagus. While triptans can sometimes cause mild gastrointestinal upset, GERD itself is not a contraindication to sumatriptan use. The mechanism of action of sumatriptan involves serotonin receptor agonism, which does not significantly exacerbate or directly interact with the pathophysiology of gastrointestinal reflux disease.

Choice B rationale

Angina pectoris is chest pain caused by reduced blood flow to the heart muscle, often due to coronary artery disease. Sumatriptan causes vasoconstriction by acting on serotonin 5-HT1B/1D receptors. This generalized vasoconstrictive effect can lead to coronary artery spasm and worsen myocardial ischemia, making it a significant contraindication in patients with cardiovascular conditions like angina pectoris or a history of myocardial infarction.

Choice C rationale

Routine acetylsalicylic acid (aspirin) use is common for its antiplatelet and analgesic properties. There is no known direct contraindication to sumatriptan use in patients taking routine acetylsalicylic acid. While both medications can affect platelet function, their mechanisms of action and indications are distinct, and concurrent use is generally considered safe if no other contraindications exist.

Choice D rationale

Eczema is an inflammatory skin condition characterized by dry, itchy patches. Eczema is a dermatological condition and does not have any physiological or pharmacological interaction with sumatriptan's mechanism of action, which primarily involves vasoconstriction in the cerebral vasculature and inhibition of trigeminal nerve activity. Therefore, eczema is not a contraindication to sumatriptan therapy.