A patient has been taking a COX-2 selective NSAID to treat pain ...

[arivle123]

A patient has been taking a COX-2 selective NSAID to treat pain associated with a recent onset of RA. The patient tells the primary care NP that the pain and joint swelling are becoming worse.
 
  The patient does not have synovitis or extraarticular manifestations of the disease. The NP will refer the patient to a rheumatologist and should expect the specialist to prescribe: a. methotrexate.
  b. corticosteroids.
  c. opioid analgesics.
  d. hydroxychloroquine.

Question 2

A 75-year-old patient who has cardiovascular disease reports insomnia and vomiting for several weeks. The primary care NP orders thyroid function tests. The tests show TSH is decreased and T4 is increased.
 
  The NP should consult with an endocrinologist and order: a. thyrotropin.
  b. methimazole.
  c. levothyroxine.
  d. propylthiouracil.

[onowka]

Answer to Question 1

D
In mild RA disease, patients are given NSAIDs first for 2 to 3 months, and then either hydroxychloroquine or sulfasalazine is added if the disease does not remit. Methotrexate is a first-line drug for patients with more aggressive symptoms, such as synovitis or extraarticular symptoms. Opioid analgesics are used as adjuncts for pain relief along with DMARDs.

Answer to Question 2

B
Patients with hyperthyroidism, or Graves' disease, will require radioactive iodine. Elderly patients and patients with cardiovascular disease should be pretreated with an antithyroid medication such as methimazole. Thyrotropin is used to diagnose thyroid cancer. Levothyroxine is used to treat hypothyroidism. Propylthiouracil is also a thyroid suppressant, but methimazole is preferred.

[arivle123]

TYSM

[amit]

Excellent