A patient who takes carbamazepine (Tegretol) has been ...

[bucstennis@aim.com]

A patient who takes carbamazepine (Tegretol) has been seizure-free for 2 years and asks the primary care NP about stopping the medication. The NP should:
 
  a. order an electroencephalogra m (EEG).
  b. prescribe a tapering regimen of the drug.
  c. inform the patient that antiepileptic drug (AED) therapy is lifelong.
  d. tell the patient to stop the drug and use only as needed.

Question 2

A primary care NP sees a patient who has dysuria, fever, and urinary frequency. The NP orders a urine dipstick, which is positive for nitrates and leukocyte esterase, and sends the urine to the laboratory for a culture.
 
  The patient is allergic to sulfa drugs. The NP should: a. order cefaclor (Ceclor).
  b. prescribe cefixime (Suprax).
  c. administer intramuscular ceftriaxone (Rocephin).
  d. wait for culture results before ordering an antibiotic.

[sylvia]

Answer to Question 1

A
Discontinuation of AEDs may be considered in patients who have been seizure-free for longer than 2 years. An EEG should be obtained before the medication is withdrawn. The drug should be tapered to prevent status epilepticus, but only after a normal EEG is obtained. AED therapy is not lifelong in all patients. Patients should not stop AED medications abruptly, and these drugs are not used on an as-needed basis.

Answer to Question 2

B
Cephalosporins are useful for empirical treatment of many of the most common infections seen in primary care. Cefixime is a third-generation cephalosporin, which has greater activity against Escherichia coli and excellent penetration into body fluids, making it a good choice for empirical treatment of urinary tract infection.

[bucstennis@aim.com]

Thank you!

[sylvia]

Always glad to help...