A patient who has partial seizures has been taking phenytoin ...

[cherise1989]

A patient who has partial seizures has been taking phenytoin (Dilantin). The patient has recently developed thrombocytopenia.
 
  The primary care nurse practitioner (NP) should contact the patient's neurologist to discuss changing the patient's medication to: a. topiramate (Topamax).
  b. levetiracetam (Keppra).
  c. zonisamide (Zonegran).
  d. carbamazepine (Tegretol).

Question 2

A patient with otitis media is treated for 10 days with amoxicillin. At the follow-up visit, the primary care NP notes bilateral erythematous, bulging tympanic membranes. The NP should prescribe:
 
  a. intramuscular injection of penicillin G (Bicillin).
  b. amoxicillin for 10 more days.
  c. oral dicloxacillin (Dynapen) for 10 days.
  d. oral amoxicillin-clavulanate (Augmentin) for 10 days.

[katkat_flores]

Answer to Question 1

D
Evidence-based recommendations exist showing carbamazepine to be effective as monotherapy for partial seizures. Because this patient has developed a serious side effect of phenytoin, changing to carbamazepine may be a good option. The other three drugs may be added to phenytoin or another first-line drug when drug-resistant seizures occur, but are not recommended as monotherapy.

Answer to Question 2

D
Antibiotic resistance to penicillins occurs through three mechanisms, the most important being bacteria producing B-lactamase, which breaks down the B-lactam ring and renders the penicillin inactive. Clavulanic acid, used in combination with penicillins, prevents this inactivation. The NP should prescribe amoxicillin-clavulanate. Giving 10 more days of amoxicillin would not be effective. Dicloxacillin is used when resistance is caused by penicillinase-resistant staphylococcal infection. Penicillin G is not used to treat otitis media.

[cherise1989]

Excellent

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Gracias!