Which effect would a nurse anticipate might occur in a patient receiving inhaled fluticasone who is also prescribed hydrochlorothiazide for hypertension?

Choice A reason: Penicillin antibiotics, like amoxicillin, inhibit bacterial cell wall synthesis and are not associated with photosensitivity. Their side effects include allergic reactions and gastrointestinal upset. Photosensitivity requires drugs that absorb UV light, altering skin response, which is not a mechanism of penicillin’s action on bacterial peptidoglycan.

Choice B reason: Cephalosporins, similar to penicillins, target bacterial cell walls and are not commonly linked to photosensitivity. Their side effects include hypersensitivity and gastrointestinal issues. Unlike drugs that cause phototoxic reactions by absorbing UV light, cephalosporins lack chromophores that trigger skin photosensitivity, making this incorrect.

Choice C reason: Tetracyclines, like doxycycline, are known to cause photosensitivity by forming phototoxic compounds under UV light exposure. These compounds generate reactive oxygen species, damaging skin cells and causing exaggerated sunburn or rashes. Patients must avoid sun exposure and use sunscreen to prevent this adverse effect during therapy.

Choice D reason: Vancomycin, used for gram-positive infections, inhibits cell wall synthesis but is not associated with photosensitivity. Its primary side effects include nephrotoxicity and red man syndrome. It does not absorb UV light or form phototoxic metabolites, making it an unlikely cause of skin reactions to sunlight.

Choice A reason: Salmeterol is a long-acting beta-2 agonist (LABA) used for maintenance therapy in asthma and COPD. It binds to beta-2 receptors, causing prolonged bronchodilation (up to 12 hours). Its slow onset makes it unsuitable for acute bronchospasm, where rapid-acting agents are needed to quickly relax airway smooth muscle.

Choice B reason: Fluticasone is an inhaled corticosteroid that reduces airway inflammation by inhibiting cytokine production and immune responses. It has no bronchodilatory effects and is not used for acute bronchospasm. Its role is in long-term asthma control, preventing exacerbations by reducing chronic inflammation, not providing immediate relief.

Choice C reason: Albuterol is a short-acting beta-2 agonist (SABA) that rapidly binds to beta-2 receptors on airway smooth muscle, stimulating adenyl cyclase to increase cyclic AMP, leading to bronchodilation within minutes. This makes it ideal for acute bronchospasm in asthma, providing quick relief of symptoms like wheezing and shortness of breath.

Choice D reason: Montelukast is a leukotriene receptor antagonist that blocks leukotriene D4 receptors, reducing inflammation and bronchoconstriction. It is used for maintenance therapy in asthma, not for acute bronchospasm, as its onset is too slow (hours to days) to provide immediate relief during an acute asthma attack.