Author Question: A primary care nurse practitioner (NP) is evaluating a patient with asthma who reports having ... (Read 29 times)

berenicecastro · **on:** Jul 24, 2018

A primary care nurse practitioner (NP) is evaluating a patient with asthma who reports having wheezing and coughing 1 or 2 days each week and awakening from sleep three or four times each month with asthma symptoms.

The patient's forced expiratory volume in 1 second (FEV1) is 80 of the predicted value. The patient's current medication regimen is an albuterol metered-dose inhaler, 2 puffs every 4 hours as needed. The NP should prescribe: a. montelukast (Singulair) po daily.
b. ipratropium bromide bid with albuterol.
c. a low-dose inhaled corticosteroid (ICS), 2 puffs bid.
d. a long-acting B-adrenergic agonist (LABA), 1 puff bid.

Question 2

A woman who is pregnant tells an NP that she has been taking sertraline for depression for several years but is worried about the effects of this drug on her fetus. The NP will consult with this patient's psychiatrist and will recommend that she:

a. stop taking the sertraline now.
b. continue taking the antidepressant.
c. change to a monoamine oxidase inhibitor (MAOI).
d. discontinue the sertraline a week before delivery.

jordangronback · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

C
This patient has symptoms of mild, persistent asthma. The preferred controller medication in adults and children with persistent asthma is a low-dose ICS. Montelukast is a leukotriene modifier, which may be considered as an alternative to a low-dose ICS but is not the first option to try. Ipratropium is often used during an acute exacerbation but not for long-term control. LABA medications are used in patients with moderate persistent symptoms.

Answer to Question 2

B
Many women are taking medication for depression before becoming pregnant. Abrupt discontinuation is not recommended, and many clinicians suggest that women at high risk for serious depression during pregnancy might best be served by continuing medication throughout pregnancy. MAOIs may limit fetal growth and are generally discouraged during pregnancy. It is not necessary to discontinue the sertraline just before delivery.