A patient who has RA has been taking methotrexate for 6 months ...

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A patient who has RA has been taking methotrexate for 6 months and tells the primary care NP that symptoms seem to be getting worse. The NP refers the patient back to the rheumatologist and should expect the rheumatologist to:
 
  a. add prednisone to the drug regimen.
  b. add adalimumab to the drug regimen.
  c. change to a combination of adalimumab and etanercept.
  d. discontinue methotrexate because 50 of patients do not respond.

Question 2

A 40-year-old patient is in the clinic for a routine physical examination. The patient has a body mass index (BMI) of 26 . The patient is active and walks a dog daily.
 
  A lipid profile reveals low-density lipoprotein (LDL) of 100 mg/dL, high-density lipoprotein (HDL) of 30 mg/dL, and triglycerides of 250 mg/dL. The primary care nurse practitioner (NP) should: a. order a fasting plasma glucose level.
  b. consider prescribing metformin (Glucophage).
  c. suggest dietary changes and increased exercise.
  d. obtain serum insulin and hemoglobin A1c levels.

[kusterl]

Answer to Question 1

B
Combination therapy generally is used because it is more effective and provides a more sustained response. Immunomodulators such as adalimumab are often used with methotrexate. Prednisone is not indicated. Immunomodulators are generally not used in combination.

Answer to Question 2

A
Testing for type 2 diabetes should be considered in all adults with a BMI greater than 25 who have risk factors such as HDL less than 35 mg/dL or triglycerides greater than 250 mg/dL. A fasting plasma glucose level greater than 126 mg/dL indicates diabetes. Metformin is not indicated unless testing is positive. Lifestyle changes may be part of the treatment plan. Serum insulin level is not indicated.

[debasdf]

TY

[kusterl]

You're welcome