A nurse is providing teaching to a client about proper administration of a medication regarding meals.
The nurse should instruct the client that the presence of food will alter the rate of which of the following pharmacokinetic processes?

Choice A rationale

Calcium levels are primarily regulated by parathyroid hormone and calcitonin and are essential for bone health and muscle function. Neither lovastatin nor ezetimibe directly impacts calcium metabolism to a degree that requires routine monitoring of serum calcium levels. Calcium monitoring is not a primary concern for these lipid-lowering medications.

Choice B rationale

Creatinine clearance is a measure of renal function, reflecting the kidney's ability to filter waste products from the blood. While some medications can affect kidney function, lovastatin and ezetimibe do not typically have significant nephrotoxic effects that necessitate routine monitoring of creatinine clearance unless pre-existing renal impairment is present.

Choice C rationale

Thyroid stimulating hormone (TSH) is produced by the pituitary gland and regulates thyroid hormone production. There is no direct pharmacological mechanism by which lovastatin or ezetimibe would significantly alter thyroid function or TSH levels. Therefore, TSH monitoring is not a standard requirement for these lipid-lowering therapies.

Choice D rationale

Both lovastatin (a statin) and ezetimibe can, albeit rarely, cause liver dysfunction, including elevated liver enzymes. Alanine aminotransferase (ALT) is a specific indicator of hepatocellular injury. Monitoring ALT is crucial to detect potential drug-induced hepatotoxicity, particularly with combination therapy, ensuring early intervention if liver damage occurs. Normal ALT is typically 7-55 U/L.

Choice A rationale

Nystagmus, an involuntary rhythmic eye movement, is not a recognized or common adverse effect of oral albuterol. Albuterol is a beta-2 adrenergic agonist primarily acting on bronchial smooth muscle to cause bronchodilation. Its side effects are typically related to sympathetic nervous system stimulation, not oculomotor dysfunction.

Choice B rationale

Tachycardia is a common adverse effect of oral albuterol due to its systemic absorption and stimulation of beta-1 adrenergic receptors in the heart, in addition to its primary beta-2 effects on the lungs. This leads to an increased heart rate (normal range 60-100 bpm) and can cause palpitations, especially in sensitive individuals or with higher doses.

Choice C rationale

Drowsiness is not a typical adverse effect of oral albuterol. In fact, due to its stimulant properties, albuterol is more likely to cause central nervous system excitation, leading to insomnia, nervousness, or tremors rather than sedation. Its action is to activate adrenergic pathways, which generally promote alertness.

Choice D rationale

Oral fungal infections, such as oral candidiasis (thrush), are commonly associated with inhaled corticosteroids, not oral albuterol. Inhaled corticosteroids suppress the local immune response in the oral cavity, allowing opportunistic fungal growth. Oral albuterol does not have immunosuppressive effects on the oral mucosa.