Author Question: An 80-year-old patient has a history of renal disease and develops a duodenal ulcer. The primary ... (Read 74 times)

bobypop · **on:** Jul 24, 2018

An 80-year-old patient has a history of renal disease and develops a duodenal ulcer. The primary care NP should order a:

a. normal dose of a histamine-2 blocker.
b. decreased dose of a histamine-2 blocker.
c. normal dose of a PPI.
d. decreased dose of a PPI.

Question 2

A patient has NSAID-induced ulcer and has started taking ranitidine (Zantac). At a follow-up appointment 3 days later, the patient reports no alleviation of symptoms. The primary care NP should:

a. order cimetidine (Tagamet).
b. add metronidazole to the drug regimen.
c. change from ranitidine to omeprazole (Prilosec).
d. reassure the patient that drug effects take several weeks.

asdfghjkl; · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

C
No adjustment of dosage is necessary for older patients taking PPIs. Patients with a history of renal disease may have decreased elimination of histamine-2 blockers, so the NP should avoid these if possible.

Answer to Question 2

C
If the patient does not start to see improvement within a few days after initiation of treatment with a histamine-2 blocker, the provider either should increase the dose of the medication or should change to a PPI. Cimetidine is a histamine-2 blocker and has many serious side effects. Metronidazole is used only when H. pylori is known to be present. Patients should start to get relief within a few days.