A patient with a history of coronary heart disease develops ...

[bobbie]

A patient with a history of coronary heart disease develops atrial fibrillation. The primary care NP refers the patient to a cardiologist who performs direct current cardioversion.
 
  The NP should expect the patient to begin taking which B-blocker medication? a. Nadolol (Corgard)
  b. Sotalol (Betapace)
  c. Timolol (Blocadren)
  d. Propranolol (Inderal)

Question 2

The primary care NP prescribes an inhaled corticosteroid for a patient who has asthma. The third-party payer for this patient denies coverage for the brand that comes in the specific strength the NP prescribes. The NP should:
 
  a. provide pharmaceutical company samples of the medication for the patient.
  b. inform the patient that the drug must be paid for out of pocket because it is not covered.
  c. order the closest formulary-approved approximation of the drug and monitor effectiveness.
  d. write a letter of medical necessity to the insurer to explain the need for this particular medication.

[stallen]

Answer to Question 1

B
Sotalol is classified as a class II and III antiarrhythmic and is a preferred agent in patients with a history of coronary heart disease.

Answer to Question 2

C
The second step of medical decision making takes into account benefits versus costs along with an understanding that it is impossible to do everything because of limited resources. The NP should prescribe what is covered and evaluate its effectiveness; if it does not work, the third-party payer may be approached about the need for the other medication. Providing samples is not always possible, and this practice is being discouraged, so it is not a viable solution. Asking patients to pay out of pocket ultimately may be necessary but carries risks that the patient will not obtain the medication. Writing a letter of medical necessity may be indicated if the available drugs are not effective but is not the initial step.

[bobbie]

Thanks

[stallen]

Welcome