A patient tells the nurse that he likes to eat large amounts of garlic to help lower his cholesterol levels naturally. The nurse reviews his medication history and notes which drug has a potential interaction with the garlic?

Choice A reason: Griseofulvin is an antifungal used for dermatophyte infections like ringworm. It disrupts fungal mitosis by binding to keratin. It is not used for systemic infections and has minimal nephrotoxicity, as it is primarily metabolized by the liver, with side effects like rash or hepatotoxicity.

Choice B reason: Fluconazole treats systemic fungal infections like candidiasis by inhibiting ergosterol synthesis. It is generally well-tolerated and not significantly nephrotoxic, as it is excreted primarily via the kidneys unchanged. Its main side effects include hepatotoxicity and gastrointestinal upset, not kidney damage.

Choice C reason: Amphotericin B is used for severe systemic fungal infections, binding to ergosterol in fungal membranes, causing cell lysis. It is highly nephrotoxic, damaging renal tubular cells and reducing glomerular filtration rate, often requiring careful monitoring of kidney function and hydration to mitigate toxicity during treatment.

Choice D reason: Terbinafine treats dermatophyte infections like onychomycosis by inhibiting squalene epoxidase. It is not typically used for systemic infections and has low nephrotoxicity risk. Its primary side effects include hepatotoxicity and gastrointestinal issues, with minimal impact on renal function compared to amphotericin B.

Choice A reason: Fluticasone propionate, an inhaled corticosteroid, reduces airway inflammation over days, not suitable for acute asthma or COPD exacerbations. Its slow onset targets chronic control, not immediate bronchodilation, making it ineffective for rapid relief of acute bronchospasm or worsening respiratory symptoms.

Choice B reason: Salmeterol, a long-acting beta-2 agonist, provides sustained bronchodilation (12 hours) for maintenance therapy. Its slow onset (20-30 minutes) makes it unsuitable for acute asthma or COPD exacerbations, where rapid-acting agents like albuterol are needed for immediate airway relaxation.

Choice C reason: Albuterol, a short-acting beta-2 agonist, has a rapid onset (within minutes) by stimulating beta-2 receptors, increasing cyclic AMP, and relaxing airway smooth muscle. This makes it the first-line choice for acute asthma attacks or COPD exacerbations, providing quick relief of bronchospasm and dyspnea.

Choice D reason: Zafirlukast, a leukotriene receptor antagonist, prevents inflammation and bronchoconstriction for asthma maintenance. Its oral administration and slow onset (hours) make it ineffective for acute asthma or COPD exacerbations, which require rapid bronchodilation from inhalers like albuterol, not leukotriene modifiers.