A primary care nurse practitioner (NP) sees a 3-year-old child ...

[rachel9]

A primary care nurse practitioner (NP) sees a 3-year-old child who has a history of recurrent otitis media. The child's parent tells the NP that the child is allergic to penicillin.
 
  The NP learns that the child developed an all-over rash 2 days after starting amoxicillin at age 2 years. The NP should: a. order a penicillin skin test.
  b. use cephalosporins when treating otitis media.
  c. order penicillin desensitization so the child can take penicillin when needed.
  d. use amoxicillin when needed because actual allergy correlates poorly with patient report.

Question 2

A patient who has migraine headaches without an aura reports difficulty treating the migraines in time because they come on so suddenly. The patient has been using over-the-counter NSAIDs. The primary care NP should prescribe:
 
  a. frovatriptan (Frova).
  b. sumatriptan (Imitrex).
  c. cyproheptadine (Periactin).
  d. dihydroergotamine (D.H.E. 45).

[tennis14576]

Answer to Question 1

A
Although it is true that patient report correlates poorly with actual allergy, there is a risk of life-threatening anaphylaxis with a true penicillin allergy. The NP should order a penicillin skin test to verify allergy. If the skin test is positive, the patient should avoid B-lactam antimicrobials. Penicillin desensitization can be used for penicillin-allergic patients who need penicillins.

Answer to Question 2

B
If the patient is able to take medication at the earliest onset of migraine, ergots are usually effective. Triptans are more effective when patients have difficulty catching the headache in time. Sumatriptan begins to work in 15 minutes and so would be indicated for this patient. Frovatriptan has a longer half-life. Cyproheptadine is not a first-line migraine treatment.

[rachel9]

Thanks

[tennis14576]

Welcome