The primary care NP is preparing to prescribe a diuretic for a ...

[mrsjacobs44]

The primary care NP is preparing to prescribe a diuretic for a patient who has heart failure. The patient reports having had an allergic reaction to sulfamethoxazole-trimethoprim (Bactrim) previously. The NP should prescribe:
 
  a. ethacrynic acid.
  b. furosemide (Lasix).
  c. acetazolamide (Diamox).
  d. hydrochlorothiazide (HydroDIURIL).

Question 2

A 60-year-old woman is in the clinic for an annual well-woman examination. She has been taking alendronate (Fosamax) 10 mg daily for 4 years. Her last bone density test yielded a T-score of 2.0 . Her urine NTx level today is 22 . She walks daily.
 
  Her fracture risk is low. The primary care NP should recommend that she: a. take a 1- to 2-year drug holiday.
  b. change to 70 mg of alendronate weekly.
  c. decrease the alendronate dose to 5 mg daily.
  d. change to ibandronate (Boniva) 3 mg IV every 3 months.

[chevyboi1976]

Answer to Question 1

A
Patients who are allergic to sulfa drugs should avoid diuretics that are sulfonamide derivatives. Ethacrynic acid is the only choice that is not a sulfonamide derivative.

Answer to Question 2

A
The American Association of Clinical Endocrinologists recommends patients have a drug holiday after 4 to 5 years of bisphosphonate treatment if osteoporosis is mild and the fracture risk is low. The other options are all viable treatment regimens but are not appropriate in this case.