A patient with ulcerative colitis takes 30 mg of ...

[fahad]

A patient with ulcerative colitis takes 30 mg of methylprednisolone (Medrol) daily. The primary care NP sees this patient for bronchitis and orders azithromycin (Zithromax). The NP should:
 
  a. order intramuscular (IM) methylprednisolone.
  b. temporarily decrease the dose of methylprednisolone.
  c. change the dosing of methylprednisolone to 15 mg twice a day.
  d. stop the methylprednisolone while the patient is taking azithromycin.

Question 2

A patient who has rheumatoid arthritis begins taking naproxen (Naprosyn) 500 mg once daily for pain. After 1 week, the patient calls the primary care NP to report no change in inflammation. The NP should:
 
  a. change the medication to tramadol.
  b. change the medication to ketorolac (Toradol).
  c. increase the dose of naproxen to 1000 mg daily.
  d. counsel the patient that pain relief may not occur for another week.

[akudia]

Answer to Question 1

B
When given concurrently with macrolide antibiotics, methylprednisolone clearance is reduced, so a smaller dose of methylprednisolone is needed. IM administration does not affect clearance of the drug. Changing the dose to twice-daily dosing is not recommended. Stopping the drug abruptly is not recommended.

Answer to Question 2

D
The analgesic effect of NSAIDs should be noticed within 1 to 4 hours of administration. However, the full antiinflammatory effect will not be apparent until after a few weeks. Tramadol and ketorolac are used for severe pain. It is not necessary to increase the dose of naproxen.

[fahad]

Wow, this really help

[Alyson.hiatt@yahoo.com]

Thanks for the timely response, appreciate it