The primary care NP has prescribed sertraline (Zoloft) for a ...

[stephzh]

The primary care NP has prescribed sertraline (Zoloft) for a patient who initially reported daily symptoms of hopelessness, sadness, insomnia, and weight loss.
 
  After several months of therapy, the patient no longer feels hopeless or sad but continues to have difficulty eating and sleeping. The NP should contact the patient's psychiatrist to discuss: a. adding mirtazapine (Remeron).
  b. changing to duloxetine (Cymbalta).
  c. adding another selective serotonin reuptake inhibitor (SSRI) antidepressant.
  d. an inpatient admission to the hospital.

Question 2

A primary care NP sees a patient who has fever, flank pain, and dysuria. The patient has a history of recurrent urinary tract infections (UTIs) and completed a course of trimethoprim-sulfamethoxazole (TMP/SMX) the week before.
 
  A urine test is positive for leukocyte esterase. The NP sends the urine for culture and should treat this patient empirically with: a. gemifloxacin.
  b. ciprofloxacin.
  c. azithromycin.
  d. TMP/SMX.

[snackralk]

Answer to Question 1

A
Mirtazapine may be added to the drug regimen for partial responders who continue to feel anxious. Changing medications is not recommended. Adding another SSRI is contraindicated because of the risk of serotonin syndrome. An inpatient hospital admission is not warranted.

Answer to Question 2

B
Fluoroquinolones are effective in treatment of UTIs that are resistant to other antibiotics. Because this patient recently completed a course of TMP/SMX, the NP can assume that the bacterium causing the infection is resistant to TMP/SMX. Gemifloxacin is not indicated for UTI, but ciprofloxacin is. Azithromycin is not a fluoroquinolone.

[stephzh]

TY

[snackralk]

You're welcome