Author Question: A patient is admitted to the coronary care unit from the emergency department after initial ... (Read 23 times)

lb_gilbert · **on:** Jul 23, 2018

A patient is admitted to the coronary care unit from the emergency department after initial management of STEMI. A primary percutaneous coronary intervention has been performed.

The nurse notes an initial heart rate of 56 beats per minute and a blood pressure of 120/80 mm Hg. The patient has a history of stroke and a previous myocardial infarction. Which order will the nurse question? a. Aspirin
b. Beta blocker
c. Clopidogrel
d. Heparin

Question 2

A patient with rheumatoid arthritis is taking leflunomide Arava and an oral contraceptive. She tells the nurse she would like to get pregnant. What will the nurse tell her?

a. That leflunomide is not dangerous during the first trimester of pregnancy
b. That plasma levels of leflunomide will drop rapidly when she stops taking it
c. To ask her provider about an 11-day course of cholestyramine
d. To stop taking leflunomide when she stops using contraception

akemokai · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

B
A beta blocker would be contraindicated in this patient, because it slows the heart, and this pa-tient is already bradycardic. Aspirin, clopidogrel, and heparin are recommended in patients who have had a primary PCI.

Answer to Question 2

C
Leflunomide is contraindicated during pregnancy. Patients desiring pregnancy must follow a three-step protocol that includes stopping the drug, taking cholestyramine to chelate the lefluno-mide, and ensuring that leflunomide drug levels are below 20 mcg/L before getting pregnant. Leflunomide is teratogenic and is not safe during pregnancy. Plasma levels of leflunomide may take 2 years to drop without using cholestyramine. It is not correct to stop taking leflunomide without following the protocol.