Author Question: A patient has confirmed Rocky Mountain spotted fever, and the infectious disease specialist is ... (Read 128 times)

piesebel · **on:** Jul 24, 2018

A patient has confirmed Rocky Mountain spotted fever, and the infectious disease specialist is treating the patient with doxycycline 100 mg orally for 7 days.

The patient comes to the clinic for follow-up care with the primary care NP at the end of therapy and reports continued fever, headache, and myalgia. The NP will consult with the infectious disease specialist and order: a. 7 more days of doxycycline.
b. erythromycin 250 mg four times daily for 7 days.
c. amoxicillin 500 mg three times daily for 10 to 14 days.
d. hospital admission for intravenous chloramphenicol.

Question 2

A primary care NP prescribes sumatriptan for abortive treatment of migraine headaches. The patient returns to the clinic 1 month later to report increased frequency of the headaches. The NP should:

a. add an opioid analgesic.
b. consider changing to dihydroergotamine (D.H.E. 45).
c. suggest that the patient take sumatriptan with a NSAID.
d. ask the patient how often the sumatriptan is used each week.

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

Answer to Question 1

D
With treatment, the patient's condition should start to improve in 2 to 3 days. Continued elevation of the temperature may indicate lack of efficacy or drug fever. Chloramphenicol is used to treat Rocky Mountain spotted fever. It is not correct to continue therapy with doxycycline because treatment failure is likely. Erythromycin is used to treat Lyme disease. Amoxicillin is not indicated.

Answer to Question 2

D
It is important that any abortive agent be administered no more often than 2 days per week to avoid the possibility of rebound headache. Patients should be encouraged to try products for at least two or three episodes of migraine before they decide they are ineffective, so changing the drug regimen may not be indicated at this time.