Liver disease is a relative contraindication to which local anesthetic agent? (Select All that Apply.)
None of the above
Esters
Inhalants
Amides
Amides
The Correct Answer is D
A. Liver disease is relevant for certain anesthetics, so this option is not correct.
B. Ester-linked local anesthetics (such as procaine, tetracaine, and chloroprocaine) are primarily metabolized by plasma pseudocholinesterases, not by the liver. Therefore, liver disease does not significantly impact their metabolism, and they are generally safer in patients with hepatic impairment.
C. Inhaled anesthetics are primarily metabolized in the lungs, with minimal hepatic metabolism for most agents. While some volatile agents undergo partial hepatic metabolism, they are not considered significantly contraindicated in liver disease.
D. Amide-linked local anesthetics (such as lidocaine, bupivacaine, and prilocaine) are metabolized primarily in the liver by hepatic enzymes. In patients with liver disease, the metabolism of amide anesthetics can be impaired, leading to drug accumulation and increased risk of systemic toxicity. Therefore, liver disease is considered a relative contraindication, and dose adjustments or alternative agents may be needed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Rolling the NPH vial before inspecting both vials risks using contaminated or expired insulin. Inspection should always occur first.
B. The correct sequence begins with inspecting the vialsfor contaminants and expiration, followed by rolling the NPH vialto resuspend it. Air is then injected into the NPH vial first and the regular insulin vial second to equalize pressure. The short-acting insulin (regular)is withdrawn first, followed by the intermediate-acting insulin (NPH), following the “clear before cloudy” rule to prevent contamination.
C. Rolling the NPH vial occurs after drawing insulin, which may result in inaccurate dosing.
D. Skipping the initial inspection of vials and rolling NPH after withdrawing insulin can risk contamination and improper mixing.
Correct Answer is B
Explanation
A. Bile-acid sequestrants, such as colesevelam, primarily lower serum cholesterol levels. While they may have a modest effect on glucose levels, they do not directly improve insulin sensitivityor significantly reduce hepatic glucose production, which are the main mechanisms of pioglitazone.
B. Thiazolidinediones (TZDs), including pioglitazone (Actos)and rosiglitazone, are oral hypoglycemic agentsused for type 2 diabetes mellitus. They work by activating peroxisome proliferator-activated receptor gamma (PPAR-γ) receptorsin adipose, muscle, and liver tissue. This leads to enhanced insulin sensitivity, improved glucose uptake in peripheral tissues, and modest reduction in hepatic glucose production. TZDs are used as adjuncts to diet and exerciseto improve glycemic control. They are usually well tolerated, with common side effects including upper respiratory tract infection, headache, sinusitis, and myalgia. However, nurses should monitor for weight gain, fluid retention, edema, and signs of heart failure, which are rare but serious adverse effects.
C. Alpha-glucosidase inhibitors(e.g., acarbose, miglitol) work by slowing carbohydrate absorptionin the small intestine to reduce postprandial hyperglycemia. They do not improve insulin sensitivityor reduce hepatic glucose production, so they are mechanistically different from TZDs.
D. Non-insulin injectable drugs, such as GLP-1 receptor agonists (e.g., liraglutide, dulaglutide), are injectable agentsthat enhance glucose-dependent insulin secretion, slow gastric emptying, and promote satiety. Pioglitazone is an oral agent, not an injectable.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.