A patient who has year-round allergic rhinitis uses an intranasal ...

[gbarreiro]

A patient who has year-round allergic rhinitis uses an intranasal corticosteroid and a daily oral antihistamine. The patient reports persistent watery and itchy eyes.
 
  The primary care NP observes profuse clear, watery discharge and a cobblestone appearance inside the upper eyelids, with clear conjunctivae. The patient has tried topical azelastine (Astelin) and topical diclofenac (Voltaren) without improvement. The NP should prescribe _____ drops. a. timolol (Timoptic)
  b. pilocarpine (Isopto)
  c. nedocromil (Tilade)
  d. dexamethasone (Decadron)

Question 2

A patient who has primary hyperlipidemia and who takes atorvastatin (Lipitor) continues to have LDL cholesterol of 140 mg/dL after 3 months of therapy. The primary care NP increases the dose from 10 mg daily to 20 mg daily.
 
  The patient reports headache and dizziness a few weeks after the dose increase. The NP should: a. change the atorvastatin dose to 15 mg twice daily.
  b. change the patient's medication to cholestyramine (Questran).
  c. add ezetimibe (Zetia) and lower the atorvastatin to 10 mg daily.
  d. recommend supplements of omega-3 along with the atorvastatin.

[tuwy]

Answer to Question 1

C
Topical mast cell stabilizers, such as nedocromil, are good for long-term treatment of allergic conjunctivitis. Timolol and pilocarpine are used to treat glaucoma. Dexamethasone is prescribed for severe cases of conjunctivitis but should be prescribed only by an ophthalmologist.

Answer to Question 2

C
When used in combination with a low-dose statin, ezetimibe has been noted to produce an additional 18 reduction in LDL. Because this patient continues to have elevated LDL along with side effects of the statin, the NP should resume the lower dose of the statin and add ezetimibe. Atorvastatin is given once daily. Cholestyramine and omega-3 supplements are not indicated.

[gbarreiro]

Excellent

[juliaf]

TYSM