Simvastatin has been prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which instructions will the nurse include? (Select all that apply)
Reduce servings of raw vegetables and fruit.
Drug interactions are rare with antilipemic agents.
Report the occurrence of muscle pain immediately.
Report abnormal or unusual bleeding or yellow discoloration of the skin.
Limit fluid intake to prevent fluid overload.
Correct Answer : C,D
Choice A reason: Reducing raw vegetables and fruit is not necessary with simvastatin. Dietary vitamin K may affect warfarin, but statins are unaffected by fruits or vegetables, except grapefruit, which inhibits CYP3A4, increasing simvastatin levels. A balanced diet supports cardiovascular health, making this instruction incorrect.
Choice B reason: Drug interactions are not rare with simvastatin, a statin metabolized by CYP3A4. Inhibitors like grapefruit juice or antifungals increase simvastatin levels, risking toxicity, while inducers reduce efficacy. Patients must be educated about potential interactions, making this statement incorrect and misleading for safe statin use.
Choice C reason: Reporting muscle pain immediately is critical with simvastatin, as it may indicate myopathy or rare rhabdomyolysis. Statins disrupt muscle cell membranes, causing pain or weakness. Early reporting allows monitoring of creatine kinase levels and prevents progression to severe muscle damage, ensuring patient safety.
Choice D reason: Reporting bleeding or yellow skin (jaundice) is essential, as simvastatin can cause hepatotoxicity, elevating liver enzymes, or rare bleeding due to drug interactions. Jaundice indicates liver dysfunction, and bleeding may result from interactions with anticoagulants, necessitating prompt reporting to adjust therapy or monitor liver function.
Choice E reason: Limiting fluid intake is not required with simvastatin. Fluid overload is unrelated to statins, which affect cholesterol synthesis, not fluid balance. Adequate hydration supports general health, and no evidence suggests fluid restriction is necessary, making this instruction irrelevant and potentially harmful.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
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.
Correct Answer is C
Explanation
Choice A reason: Loratadine has no significant advantage in reducing cardiac dysrhythmias compared to diphenhydramine. Both are H1 receptor antagonists, with minimal cardiac effects at therapeutic doses. Older antihistamines like terfenadine had dysrhythmia risks, but loratadine and diphenhydramine are not primarily associated with this issue.
Choice B reason: Loratadine causes minimal gastrointestinal upset, but this is not its primary advantage over diphenhydramine. Both antihistamines have low gastrointestinal side effects, with diphenhydramine’s anticholinergic effects causing more dry mouth. Loratadine’s key benefit is reduced CNS penetration, minimizing sedation.
Choice C reason: Loratadine, a second-generation antihistamine, has less sedative effect than diphenhydramine, a first-generation antihistamine. Its reduced ability to cross the blood-brain barrier minimizes H1 receptor blockade in the CNS, decreasing drowsiness, making it ideal for daytime use in allergic conditions.
Choice D reason: Neither loratadine nor diphenhydramine significantly increases bronchodilation. Antihistamines block histamine-mediated allergic responses, not beta-2 receptors responsible for bronchodilation. Bronchodilation is achieved with beta-agonists like albuterol, making this an incorrect advantage for loratadine over traditional antihistamines.
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