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Author Question: A patient has been treated for severe contact dermatitis on both arms with clobetasol propionate ... (Read 77 times)

joblessjake

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on: Jul 24, 2018
A patient has been treated for severe contact dermatitis on both arms with clobetasol propionate cream. At a follow-up visit, the primary care NP notes that the condition has cleared. The NP should:
 
  a. prescribe triamcinolone cream for 2 weeks.
  b. recommend continuing treatment for 2 more weeks.
  c. discontinue the clobetasol and schedule a follow-up visit in 2 weeks.
  d. discontinue the clobetasol and recommend prn use for occasional flare-ups.

Question 2

A patient who is taking an ACE inhibitor sees the primary care NP for a follow-up visit. The patient reports having a persistent cough. The NP should:
 
  a. consider changing the medication to an ARB.
  b. order a bronchodilator to counter the bronchospasm caused by this drug.
  c. ask whether the patient has had any associated facial swelling with this cough.
  d. reassure the patient that tolerance to this adverse effect will develop over time.


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joshraies

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Reply #1 on: Jul 24, 2018
Answer to Question 1

A
Treatment should be discontinued when the skin condition has resolved. Tapering the corticosteroid will prevent recurrence of the skin condition. Tapering is best done by gradually reducing the potency and dosing frequency at 2-week intervals. This patient was on a very high potency steroid, so changing to a medium frequency with follow-up in 2 weeks is an appropriate action. Discontinuing the steroid abruptly can lead to recurrence.

Answer to Question 2

A
A persistent cough may occur with ACE inhibitors and may warrant discontinuation of the drug. An ARB would be the next drug of choice because it does not have this side effect. The cough is not related to bronchospasm. Angioedema is not related to ACE inhibitorinduced cough. Patients do not develop tolerance to this side effect.


joblessjake

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Reply #2 on: Jul 24, 2018
Thanks


joshraies

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Reply #3 on: Jul 24, 2018
Welcome :)


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