A patient with erosive esophagitis is taking lansoprazole ...

[magmichele12]

A patient with erosive esophagitis is taking lansoprazole (Prevacid). The primary care NP performs a medication history and learns that the patient also takes digoxin. The NP should recommend:
 
  a. decreasing the dose of digoxin.
  b. obtaining a serum digoxin level.
  c. changing the PPI to omeprazole.
  d. increasing the dose of lansoprazole.

Question 2

An 80-year-old patient with congestive heart failure has a viral upper respiratory infection. The patient asks the primary care NP about treating the fever, which is 38.5 C. The NP should:
 
  a. recommend acetaminophen.
  b. recommend high-dose acetaminophen.
  c. tell the patient that antibiotics are needed with a fever that high.
  d. tell the patient a fever less than 40 C does not need to be treated.

[jaymee143]

Answer to Question 1

B
Because PPIs decrease gastric acid, they may interfere with the absorption of drugs that require absorption in an acid stomach, including digoxin. It may be necessary to increase the dose of digoxin but not before obtaining a serum digoxin level. All PPIs have this effect, so changing to another PPI would not solve the problem. Increasing the dose of lansoprazole would decrease the absorption of digoxin.

Answer to Question 2

A
Patients with congestive heart failure may have tachycardia from fever that aggravates their symptoms, so fever should be treated. High doses should be given with caution in elderly patients because of possible decreased hepatic function. Antibiotics should not be given without evidence of bacterial infection.

[magmichele12]

TYSM

[nguyenhoanhat]

Great answer, keep it coming