The primary care NP administers penicillin G (Bicillin) to a ...

[shofmannx20]

The primary care NP administers penicillin G (Bicillin) to a 75-year-old patient who has COPD and heart failure. The patient takes digoxin, warfarin, and spironolactone. To help prevent drug interactions, the NP should order:
 
  a. serum electrolytes.
  b. coagulation studies.
  c. creatinine clearance.
  d. liver transaminases aspartate aminotransferase and alanine aminotransferase.

Question 2

A patient who experiences migraines characterized by unilateral motor and sensory symptoms tells the primary care NP that despite abortive therapy with a triptan, the frequency of episodes has increased to three or four times each month.
 
  The NP should: a. add a selective serotonin reuptake inhibitor (SSRI) antidepressant.
  b. change to dihydroergotamine hydrochloride.
  c. prescribe a -blocker such as propranolol.
  d. prescribe an anticonvulsant such as topiramate.

[duke02]

Answer to Question 1

A
Penicillin G can cause hyperkalemia, which can increase digoxin toxicity, so serum electrolytes should be monitored. Penicillin G does not interact with warfarin or spironolactone. Coagulation studies, creatinine clearance, and LFTs are not indicated in this circumstance.

Answer to Question 2

D
Topiramate is useful for migraine prophylaxis. SSRI antidepressants are considered second-line treatment for prophylaxis and are less effective than tricyclic antidepressants. Ergotamines are not used as prophylaxis. -Blockers are commonly used but may aggravate neurologic symptoms associated with hemiplegic or basilar migraine, which is what this patient has.

[shofmannx20]

Thanks for the timely response, appreciate it

[debra928]

Gracias!