Mrs. Oza, age 69, has hypertension and has one functioning kidney. She loves chocolates and enjoys an alcoholic beverage twice a week. Her hobby is gardening and she goes for long walks despite having arthritis. Which one of the following pieces of information is likely to have the greatest significance if she is prescribed vancomycin?

She only has one functioning kidney

She remains outdoors for long periods of time

She has hypertension

She enjoys an alcoholic beverage twice a week

Answer and Explanation

The Correct Answer is A

A. She only has one functioning kidney:

This choice is the most significant consideration when prescribing vancomycin to Mrs. Oza. Vancomycin is primarily eliminated from the body through the kidneys. Individuals with reduced kidney function, such as Mrs. Oza with only one functioning kidney, have a higher risk of vancomycin-associated nephrotoxicity (kidney damage). Therefore, her renal status is crucial information for determining the appropriate dosage of vancomycin and monitoring for any signs of kidney impairment during treatment.

B. She remains outdoors for long periods of time:

While spending time outdoors for long periods may have implications for Mrs. Oza's overall health, it is not directly relevant to the prescription of vancomycin. This information may be important for considering sun exposure, hydration, and other factors related to her arthritis and general well-being, but it does not specifically impact the pharmacokinetics or pharmacodynamics of vancomycin.

C. She has hypertension:

Mrs. Oza's hypertension is a relevant medical condition to consider in her overall health management. However, hypertension alone does not directly affect the prescription of vancomycin. Hypertension may influence the choice of antihypertensive medications or other aspects of her medical care, but it does not have a direct impact on the renal clearance or potential nephrotoxicity of vancomycin.

D. She enjoys an alcoholic beverage twice a week:

While alcohol consumption can interact with certain medications and impact overall health, it is not the most significant consideration when prescribing vancomycin to Mrs. Oza. Moderate alcohol consumption is unlikely to directly affect the pharmacokinetics or pharmacodynamics of vancomycin. However, excessive alcohol intake may contribute to liver dysfunction, which could indirectly influence drug metabolism. Nonetheless, in Mrs. Oza's case, her reduced renal function is a more critical factor to consider when prescribing vancomycin.

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Correct Answer is D

Explanation

A. A Vitamin C deficiency:

While a Vitamin C deficiency can lead to oral health issues such as bleeding gums or scurvy, it is less likely to present with bright red oral mucous membranes and white patches. Vitamin C deficiency typically manifests with other symptoms such as fatigue, weakness, and joint pain.

B. Dehydration:

Dehydration can cause dry mouth and oral discomfort, but it is less likely to present with bright red oral mucous membranes and white patches. Dehydration may also result in a dry, sticky feeling in the mouth rather than soreness with white patches.

C. Poor oral hygiene:

Poor oral hygiene can lead to various oral health problems, including gingivitis and dental caries, but it is less likely to cause bright red oral mucous membranes with white patches. Poor oral hygiene typically results in plaque accumulation, gum inflammation, and dental decay rather than the specific symptoms described.

D. A superinfection:

This is the correct option. A superinfection occurs when opportunistic microorganisms, such as fungi or resistant bacteria, proliferate and cause infection following antibiotic therapy. Penicillin, like other antibiotics, can disrupt the normal balance of microorganisms in the mouth, allowing opportunistic pathogens to flourish and lead to conditions such as oral thrush (caused by Candida albicans) or oral candidiasis. The presence of bright red oral mucous membranes with white patches suggests the possibility of a superinfection, which warrants immediate attention from the primary care provider for further evaluation and management.

A. antagonistic reaction B. drug idiosyncracy C. synergistic reaction D. allergic reaction

Correct Answer is D

Explanation

A. Antagonistic reaction:

An antagonistic reaction refers to a response where one substance opposes the action of another substance. In the context of hypersensitivity reactions, this term does not accurately describe the immune system's response to an allergen. Hypersensitivity reactions involve an overreaction of the immune system to a harmless substance, rather than opposing actions between substances. Therefore, choice A is not the correct term to describe hypersensitivity reactions.

B. Drug idiosyncrasy:

Drug idiosyncrasy refers to an unusual or unexpected response to a medication that is not related to the known pharmacological properties of the drug or the patient's characteristics. While idiosyncratic drug reactions can sometimes involve immune-mediated mechanisms, they are not synonymous with hypersensitivity reactions. Hypersensitivity reactions specifically involve the immune system's exaggerated response to an allergen, which may or may not be a medication. Therefore, while drug idiosyncrasy may involve unpredictable reactions, it does not specifically address the immune-mediated nature of hypersensitivity reactions.

C. Synergistic reaction:

A synergistic reaction occurs when the combined effect of two substances is greater than the sum of their individual effects. In the context of hypersensitivity reactions, this term does not accurately describe the immune system's response to an allergen. Hypersensitivity reactions involve an exaggerated response of the immune system to an allergen, rather than a synergistic interaction between substances. Therefore, choice C is not the correct term to describe hypersensitivity reactions.

D. Allergic reaction:

An allergic reaction is the correct term to describe hypersensitivity reactions. Hypersensitivity reactions involve the immune system's exaggerated response to a harmless substance, known as an allergen. This response can manifest in various symptoms, ranging from mild to severe, depending on the individual's sensitivity and the nature of the allergen. Allergic reactions can affect different organ systems and can be triggered by a wide range of substances, including foods, medications, environmental allergens, and insect venom. Therefore, choice D accurately describes hypersensitivity reactions.

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Naxlex Comprehensive Predictor Exams

Mr. Thomas, who is receiving oral penicillin, reports that he has a sore mouth. On inspection, the nurse notes bright red oral mucous membranes with some white patches. The primary care provider is notified immediately because these symptoms may be caused by:

Correct Answer is D

Explanation

A patient asks the nurse to define hypersensitivity reaction. The nurse begins by telling the patient that a hypersensitivity reaction is also called:

Correct Answer is D

Explanation

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