Patients taking which cholesterol-lowering agent may require supplements of fat-soluble vitamins A, D, E, and K?

Nitroglycerin transdermal patches are used to prevent episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart).Nitroglycerin is a vasodilator that works by relaxing the blood vessels so that the heart does not need to work as hard and therefore does not need as much oxygen.However, if nitroglycerin is used continuously, the body may develop tolerance to its effects, meaning that it will not work as well to prevent angina attacks.Therefore, it is important to remove the patch at bedtime and apply a new one in the morning, leaving a 10-12 hour nitrate-free interval.This way, the body can restore its sensitivity to nitroglycerin and avoid angina episodes during the day.

Choice A is wrong because allergic response is not a common reason to remove the patch at night.Although some people may experience skin irritation or rash from the patch, this is usually mild and does not require discontinuation of the medication.If the skin reaction is severe or bothersome, the patch can be applied to a different area of the skin or switched to another form of nitroglycerin.

Choice C is wrong because overdose is unlikely to occur from using the patch as prescribed.Nitroglycerin patches come in doses ranging from 0.1 milligrams per hour to 0.8 mg/hr, and should be placed on clean, dry, and hairless skin for 12-14 hours and removed for 10-12 hours.If a patch loosens or falls off, it should be replaced with a fresh one.Overdose symptoms may include severe headache, dizziness, blurred vision, nausea, vomiting, sweating, chest pain, fast or irregular heartbeat, difficulty breathing, fainting, or seizures.If these occur, the patch should be removed immediately and medical attention should be sought.

Choice D is wrong because management of BPH (benign prostatic hyperplasia) is not related to nitroglycerin use.

BPH is a condition

Digibind is the trade name forantidigoxin, which is an antibody made up of anti-digoxin immunoglobulin fragments.It is thespecific antidoteto digoxin toxicity, which can occur even when the serum digoxin concentration is within the therapeutic range.Digoxin toxicity causes anorexia, nausea, vomiting, neurological symptoms and arrhythmias.

Choice A, Protamine sulfate, is wrong because it is the antidote for heparin overdose, not digoxin toxicity.

Protamine sulfate reverses the anticoagulant effect of heparin by binding to it and forming a stable complex.

Choice B, Acetylcysteine, is wrong because it is the antidote for acetaminophen overdose, not digoxin toxicity.

Acetylcysteine replenishes glutathione, which is depleted by acetaminophen metabolites that cause hepatotoxicity.

Choice D, Vitamin K, is wrong because it is the antidote for warfarin overdose, not digoxin toxicity.

Vitamin K restores the synthesis of clotting factors that are inhibited by warfarin.

Normal ranges for serum digoxin concentration are 0.6 to 1.2 nanomol/L (0.5 to 0.9 nanograms/mL) for heart failure and unknown for atrial fibrillation without heart failure.

Normal ranges for serum potassium level are 3.5 to 5.0 mmol/L and for serum magnesium level are 0.7 to 1.0 mmol/L.