A parent brings in a 2-month-old infant with a 5-day history of a ...

[stephzh]

A parent brings in a 2-month-old infant with a 5-day history of a white coating on the tongue and decreased oral intake. The primary care NP should prescribe:
 
  a. clotrimazole, one troche tid.
  b. chlorhexidine, 15 mL oral rinse bid.
  c. carbamide peroxide, 2 to 3 drops tid.
  d. nystatin oral suspension, 200,000 units qid.

Question 2

A patient who has hyperlipidemia has been taking atorvastatin (Lipitor) 60 mg daily for 6 months. The patient's initial lipid profile showed LDL of 180 mg/dL, HDL of 45 mg/dL, and triglycerides of 160 mg/dL.
 
  The primary care NP orders a lipid profile today that shows LDL of 105 mg/dL, HDL of 50 mg/dL, and triglycerides of 120 mg/dL. The patient reports muscle pain and weakness. The NP should: a. order liver function tests (LFTs).
  b. order a creatine kinase-MM (CK-MM) level.
  c. change atorvastatin to twice-daily dosing.
  d. add gemfibrozil (Lopid) to the patient's medication regimen.

[bigsis44]

Answer to Question 1

D
Nystatin is an antifungal medication and is indicated for treatment of oral candidiasis, or thrush. Clotrimazole is an antifungal but is not indicated for oral candidiasis in infants because the patient must be able to allow the troche to dissolve. Chlorhexidine is used to treat gingivitis. Carbamide peroxide is used to treat minor oral inflammation.

Answer to Question 2

B
Hepatotoxicity and muscle toxicity are the two primary adverse effects of greatest concern with statin use. Patients who report muscle discomfort or weakness should have a CK-MM level drawn. LFTs are indicated with signs of hepatotoxicity. It is not correct to change the dosing schedule. Gemfibrozil is not indicated.

[stephzh]

TY

[bigsis44]

You're welcome