A primary care NP prescribes oxybutynin chloride for an ...

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A primary care NP prescribes oxybutynin chloride for an 80-year-old patient to treat urinary incontinence. When teaching this patient about this medication, the NP should tell the patient:
 
  a. to increase intake of fluids and fiber.
  b. that alcohol may be consumed in moderation.
  c. that drowsiness may be a transient adverse effect.
  d. that hypertension may occur and to report headaches.

Question 2

A patient is given a diagnosis of peptic ulcer disease. A laboratory test confirms the presence of Helicobacter pylori. The primary care NP orders a proton pump inhibitor (PPI) before meals twice daily, clarithromycin, and amoxicillin.
 
  After 14 days of treatment, H. pylori is still present. The NP should order: a. continuation of the PPI for 4 to 8 weeks.
  b. a PPI, amoxicillin, and metronidazole for 14 days.
  c. a PPI, clarithromycin, and amoxicillin for 14 more days.
  d. a PPI, bismuth subsalicylate, tetracycline, and metronidazole.

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Answer to Question 1

A
Oxybutynin chloride is an anticholinergic drug and can cause dry mouth and constipation. Patients should be taught to increase fluids and fiber. Patients should be cautioned to avoid alcoholic beverages. Drowsiness occurs but does not subside, and elderly patients are at increased risk for this side effect. Anticholinergics cause hypotension.

Answer to Question 2

B
A PPI, along with amoxicillin and metronidazole, is used as first-line treatment in macrolide-allergic patients and for re-treatment for 14 days if first-line treatment of choice failed because of occasional resistance to clarithromycin.