A patient who has migraine headaches usually has two to three ...

[stephzh]

A patient who has migraine headaches usually has two to three severe migraines each month. The patient has been using a triptan nasal spray but reports little relief and is concerned about missing so many days of work.
 
  The primary care NP should consider: a. an oral triptan plus an opioid analgesic.
  b. an injectable triptan plus an oral corticosteroid.
  c. an intramuscular steroid plus an opioid analgesic.
  d. dihydroergotamine hydrochloride plus an opioid analgesic.

Question 2

A patient is taking dicloxacillin (Dynapen) 500 mg every 6 hours to treat a severe penicillinase-resistant infection. At a 1-week follow-up appointment, the patient reports nausea, vomiting, and epigastric discomfort. The primary care NP should:
 
  a. change the medication to a cephalosporin.
  b. decrease the dose to 250 mg every 6 hours.
  c. reassure the patient that these are normal adverse effects of this drug.
  d. order blood cultures, a white blood cell (WBC) count with differential, and liver function tests (LFTs).

[Toya9913]

Answer to Question 1

B
For severe migraines, an injectable triptan should be considered along with corticosteroids or opioids as rescue medications. Oral triptans are not as effective for severe migraines. Ergotamines may be tried as second-line therapy.

Answer to Question 2

D
When giving penicillinase-resistant penicillins, it is important to monitor therapy with blood cultures, WBC with differential cell counts, and LFTs before treatment and weekly during treatment. This patient may have typical gastrointestinal side effects, but the symptoms may also indicate hepatic damage. Changing the medication is not indicated, unless serious side effects are present. Decreasing the dose is not indicated.

[stephzh]

Excellent

[dawsa925]

TYSM