A 60-year-old female patient has begun taking a daily ...

[Marty]

A 60-year-old female patient has begun taking a daily bisphosphonate to prevent osteoporosis and complains of gastrointestinal (GI) upset and dyspepsia. The primary care NP's initial response should be to:
 
  a. prescribe a proton pump inhibitor (PPI).
  b. order intravenous (IV) bisphosphonates.
  c. suggest that she take the drug with food.
  d. review the instructions for taking the drug with the patient.

Question 2

A patient with congestive heart failure will begin therapy with a diuretic medication. The primary care NP orders laboratory tests, which reveal a glomerular filtration rate (GFR) of 25 mL/minute. The initial drug the NP should prescribe is:
 
  a. metolazone.
  b. furosemide (Lasix).
  c. spironolactone (Aldactone).
  d. hydrochlorothiazide (HydroDIURIL).

[gstein359]

Answer to Question 1

D
Oral bisphosphonates must be taken on an empty stomach, and the patient must remain upright and not eat or drink anything for 30 to 60 minutes. GI upset and dyspepsia are frequent and can be minimized with correct administration. A PPI is not indicated. IV bisphosphonates may be indicated if the patient is unable to tolerate the oral drug after correct administration is confirmed. Bisphosphonates should not be taken with food.

Answer to Question 2

A
Thiazides are the most frequently used and the least expensive drugs administered to treat hypertension and are considered first-line treatments. In patients with a GFR less than 30 mL/minute, thiazides are relatively ineffective, with the exception of metolazone. Furosemide may be added as a second-line drug. Potassium-sparing diuretics, such as spironolactone, should be used with great caution or avoided altogether in patients with renal insufficiency.

[Marty]

Excellent

[raenoj]

TYSM