What advantage does loratadine have compared with traditional antihistamines such as diphenhydramine?

Choice A reason: Increased appetite is not a common side effect of inhaled corticosteroids due to their minimal systemic absorption. Systemic corticosteroids, like prednisone, stimulate appetite by altering metabolism and increasing hunger signals, but inhaled forms like fluticasone primarily act locally in the lungs, limiting such systemic effects.

Choice B reason: Oral thrush (candidiasis) is a frequent side effect of inhaled corticosteroids. Residual drug in the oral cavity disrupts local microbial flora, promoting Candida albicans overgrowth. Rinsing the mouth after use reduces this risk by removing excess corticosteroid, preventing fungal infections while maintaining anti-inflammatory effects in the airways.

Choice C reason: Hypertension is not typically caused by inhaled corticosteroids, as their systemic absorption is low. Systemic corticosteroids can cause fluid retention and increased blood pressure via mineralocorticoid effects, but inhaled forms like budesonide have minimal impact on cardiovascular parameters, making this an unlikely side effect.

Choice D reason: Constipation is not associated with inhaled corticosteroids. Their action is localized to the respiratory tract, with negligible gastrointestinal effects due to low systemic bioavailability. Systemic corticosteroids may cause metabolic changes, but constipation is not a reported side effect, and inhaled forms do not affect bowel motility.

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.