A 70-year-old patient who has COPD takes theophylline daily and ...

[abern]

A 70-year-old patient who has COPD takes theophylline daily and uses a SABA for exacerbation of symptoms. The patient reports using the SABA three or four times each week when short of breath.
 
  The patient reports feeling jittery and nauseated and having trouble sleeping. The primary care NP should: a. obtain a serum theophylline level.
  b. order a creatinine clearance level.
  c. prescribe a leukotriene modifier instead of theophylline.
  d. discontinue the SABA and change to ipratropium bromide.

Question 2

A primary care NP recommends an over-the-counter medication for a patient who has acid reflux. When teaching the patient about this drug, the NP should tell the patient:
 
  a. to take the dose recommended by the manufacturer.
  b. not to worry about taking this drug with any other medications.
  c. to avoid taking other drugs that cause sedation while taking this drug.
  d. that over-the-counter acid reflux medications are generally safe to take with other medications.

[zacnyjessica]

Answer to Question 1

A
Nausea, vomiting, insomnia, jitteriness, and other symptoms may indicate theophylline toxicity. Serum concentration monitoring should be done whenever signs of toxicity are suspected. A serum creatinine clearance level is not indicated. Leukotriene modifiers are not used for COPD. Ipratropium is used as an adjunct to the SABA during acute exacerbations.

Answer to Question 2

A
Because patients often increase over-the-counter drug doses themselves, it is important to reinforce the need to follow the manufacturer's recommendations for dosing. As with any drug, interactions may occur with other medications. Antacids do not cause sedation, so patients need not be cautioned to avoid other sedating medications.

[abern]

TYSM

[bigsis44]

Excellent