A nurse is teaching a class about pharmacodynamics. The nurse should include that which of the following medication levels occurs when a medication is at the lowest serum concentration?

A) Duloxetine: Duloxetine, an SNRI (Serotonin-Norepinephrine Reuptake Inhibitor), is commonly used for depression and chronic pain. It can cause orthostatic hypotension, especially in older adults, due to its effects on norepinephrine, which can lead to blood pressure fluctuations upon standing.

B) Furosemide: Furosemide is a loop diuretic that increases urine output, leading to a decrease in blood volume. This reduction in blood volume can result in orthostatic hypotension, particularly when the client changes positions quickly, such as moving from lying down to standing.

C) Telmisartan: Telisartan is an angiotensin II receptor blocker (ARB) used to treat hypertension. It can cause vasodilation and a reduction in blood pressure, which may lead to orthostatic hypotension, especially in older adults who are more sensitive to blood pressure changes.

D) Atorvastatin: Atorvastatin, a statin used to lower cholesterol, does not typically cause orthostatic hypotension. Its primary action is on lipid levels rather than blood pressure, making it less likely to contribute to this condition.

E) Clopidogrel: Clopidogrel is an antiplatelet medication that reduces the risk of blood clots. It does not generally affect blood pressure or cause orthostatic hypotension, as its mechanism of action is related to inhibiting platelet aggregation rather than influencing vascular tone or fluid balance.

A) Ask the client to inhale the medication quickly for 1 second:
The client should inhale the medication slowly and deeply, not quickly. A rapid inhalation can reduce the effectiveness of the medication as it may not reach the deeper parts of the lungs effectively.

B) Ask the client to hold their breath for 2 seconds after inhalation:
The client should hold their breath for about 10 seconds after inhalation to allow the medication to settle in the lungs and be absorbed. Holding the breath for just 2 seconds is typically insufficient for optimal medication delivery.

C) Shake the MDI prior to administration:
Shaking the MDI before use is important to ensure that the medication is properly mixed and delivered in the correct dose. Failure to shake the MDI can result in an uneven distribution of medication.

D) Wash the MDI canister in warm water after each use:
The MDI canister should not be washed frequently, as this can affect the device's function and lead to potential contamination. The canister should be cleaned as per the manufacturer’s instructions, typically every few days or as needed.