A patient comes to the clinic and asks the primary care NP about ...

[lb_gilbert]

A patient comes to the clinic and asks the primary care NP about using a newly developed formulation of the drug the patient has been taking for a year. When deciding whether or not to prescribe this formulation, the NP should:
 
  a. tell the patient that when postmarketing data is available, it will be considered.
  b. review the pharmaceutical company promotional materials about the new medication.
  c. prescribe the medication if it is less expensive than the current drug formulation.
  d. prescribe the medication if the new drug is available in an extended-release form.

Question 2

A patient who has been taking propranolol for 6 months reports having nocturnal cough and shortness of breath. The primary care NP should:
 
  a. tell the patient to stop taking the medication.
  b. obtain serum drug levels to monitor for toxicity of this medication.
  c. instruct the patient to increase activity and exercise to counter these side effects.
  d. contact the patient's cardiologist to discuss changing to a selective B-blocker.

[isabelt_18]

Answer to Question 1

A
About 6 to 12 months of postmarketing experience can yield information about drug efficacy and side effects, so patients should be cautioned to wait for these data. Drug company promotional materials have biased information. Most new drugs are more expensive, and costs alone should not determine drug choice. Extended-release forms are often more expensive.

Answer to Question 2

D
Nocturnal cough and shortness of breath may be a side effect of propranolol, which can cause bronchospasm because it is a nonselective -blocker. The NP should discuss a selective B-blocker with the patient's cardiologist. -Blockers should never be stopped abruptly. Bradycardia and hypotension are signs of toxicity. Increasing activity would not counter these side effects if bronchospasm is the cause.

[lb_gilbert]

Excellent

[CAPTAINAMERICA]

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