An 80-year-old patient has a history of renal disease and ...

[bobypop]

An 80-year-old patient has a history of renal disease and develops a duodenal ulcer. The primary care NP should order a:
 
  a. normal dose of a histamine-2 blocker.
  b. decreased dose of a histamine-2 blocker.
  c. normal dose of a PPI.
  d. decreased dose of a PPI.

Question 2

A patient has NSAID-induced ulcer and has started taking ranitidine (Zantac). At a follow-up appointment 3 days later, the patient reports no alleviation of symptoms. The primary care NP should:
 
  a. order cimetidine (Tagamet).
  b. add metronidazole to the drug regimen.
  c. change from ranitidine to omeprazole (Prilosec).
  d. reassure the patient that drug effects take several weeks.

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Answer to Question 1

C
No adjustment of dosage is necessary for older patients taking PPIs. Patients with a history of renal disease may have decreased elimination of histamine-2 blockers, so the NP should avoid these if possible.

Answer to Question 2

C
If the patient does not start to see improvement within a few days after initiation of treatment with a histamine-2 blocker, the provider either should increase the dose of the medication or should change to a PPI. Cimetidine is a histamine-2 blocker and has many serious side effects. Metronidazole is used only when H. pylori is known to be present. Patients should start to get relief within a few days.

[bobypop]

TYSM

[rachel]

Excellent