A patient is taking a combination of antiviral drugs as treatment for early stages of a viral infection. While discussing the drug therapy, the patient asks the nurse if the drugs will kill the virus. When answering, the nurse keeps in mind which fact about antiviral drugs?

Choice A reason: Drowsiness is not a systemic effect of inhaled albuterol, a beta-2 agonist. Albuterol stimulates beta-adrenergic receptors, increasing cyclic AMP, which can cause CNS stimulation, not sedation. Drowsiness is more associated with antihistamines or other CNS-depressant drugs, not bronchodilators like albuterol.

Choice B reason: Bradycardia is unlikely with albuterol, which activates beta-2 receptors and, to a lesser extent, beta-1 receptors in the heart, potentially causing tachycardia. Systemic absorption of inhaled albuterol can increase heart rate, not decrease it, as it stimulates sympathetic activity, making this incorrect.

Choice C reason: Heartburn is not a recognized systemic effect of inhaled albuterol. While gastrointestinal irritation may occur with oral beta-agonists, inhaled albuterol has minimal systemic absorption, targeting airway smooth muscle. Its side effects are primarily cardiovascular or neurological, not gastrointestinal, making this an incorrect choice.

Choice D reason: Palpitations are a possible systemic effect of inhaled albuterol due to its beta-adrenergic stimulation. Even with low systemic absorption, albuterol can stimulate cardiac beta-1 receptors, increasing heart rate and causing palpitations. This is a known side effect, particularly in sensitive patients or with overuse.

Choice A reason: Monitoring alone is insufficient with elevated ALT and AST, indicating liver dysfunction. Metronidazole is metabolized by the liver, and hepatotoxicity is a known risk. Administering it to a patient with pre-existing liver damage could worsen hepatic injury, making this action inadequate.

Choice B reason: Elevated ALT and AST suggest liver dysfunction, and metronidazole, metabolized hepatically, can exacerbate hepatotoxicity. Avoiding administration prevents further liver damage, as the drug’s nitroimidazole structure undergoes hepatic reduction, producing toxic metabolites that stress an already compromised liver, necessitating alternative therapy.

Choice C reason: Reducing the metronidazole dose is not recommended without medical consultation. Elevated liver enzymes indicate impaired hepatic function, and even reduced doses may worsen hepatotoxicity. Alternative antibiotics with less hepatic metabolism should be considered, making dose reduction an unsafe choice.

Choice D reason: Administering metronidazole as prescribed is dangerous with elevated ALT and AST, signaling liver dysfunction. Metronidazole’s hepatic metabolism can exacerbate liver injury, increasing the risk of severe hepatotoxicity. The nurse should withhold the drug and consult the prescriber for safer alternatives.