A patient who has type 2 diabetes mellitus takes metformin ...

[karateprodigy]

A patient who has type 2 diabetes mellitus takes metformin (Glucophage). The patient tells the primary care NP that he will have surgery in a few weeks. The NP should recommend:
 
  a. taking the metformin dose as usual the morning of surgery.
  b. using insulin during the perioperative and postoperative periods.
  c. that the patient stop taking metformin several days before surgery.
  d. adding a sulfonylurea medication until recovery from surgery is complete.

Question 2

A woman with IBS has been taking antispasmodic medications and reports some relief, but she tells the primary care NP that the disease is interfering with her ability to work because of increased pain. The NP should consider prescribing:
 
  a. alosetron (Lotronex).
  b. misoprostol (Cytotec).
  c. simethicone (Phazyme).
  d. tricyclic antidepressants (TCAs).

[ilianabrrr]

Answer to Question 1

B
Insulin should be considered for patients with diabetes during times of physical stress, such as illness or surgery.

Answer to Question 2

D
TCAs and selective serotonin reuptake inhibitors (SSRIs) have been shown to reduce symptoms and are useful for long-term treatment. Alosetron is ordered by a GI specialist if symptoms are resistant to all other interventions and has been shown to be effective in women with diarrhea-predominant IBS. Misoprostol is used to treat NSAID-induced ulcers. Simethicone acts locally to treat symptoms of trapped air and gas.

[karateprodigy]

Gracias!

[Alyson.hiatt@yahoo.com]

TYSM