CPJE Clinical Quizzes & Answers(graded A+)

CPJE Clinical Quizzes & Answers(graded A+)Paul is a patient in the step-down unit. A basal metabolic panel is taken and Paul is found to have a sodium level of 132 mEq/L. His medications include levothyroxine, losartan, fluticasone, chlorthalidone, Lamictal, Trileptal and Celexa. Which of the patient's medications could be contributing to the low serum sodium level? - ANSWER Chlorthalidone, trileptal and celexa. Patients taking either carbamazepine, oxcarbazepine, SSRIs or SNRIs and thiazide diuretics should have sodium checked, especially if symptoms of hyponatremia are present. Hypothyroidism can cause hyponatremia, but not levothyroxine. The most likely cause of low sodium levels is fluid loss. Maureen is a 45 year-old female who takes the following medications: clopidogrel 75 mg once daily, aspirin EC 81 mg once daily, Toprol XL 50 mg once daily and Nitrostat 0.4 mg 1 tablet SL PRN. Maureen has a long history of schizoaffective disorder. She is not currently taking any medication for this condition. Which of the following options represents the safest choice in this patient? - ANSWER Seroquel because in this patient, it is best to avoid drugs with higher QT prolongation risk due to the presence of co-existing coronary artery disease. Which of the following antifungal agents is limited to one dose intravenous (followed by oral dosing) with reduced renal function due to the accumulation of a renally-cleared component in the IV formulation? - ANSWER Voriconazole, CrCl cutoff is 50 ml/min Manuel has been discharged on linezolid 600 mg twice daily, to be taken at home for 6 weeks. He should be counseled on the risk of this adverse effect, which can occur with long-term use of linezolid: - ANSWER Myelosuppression and neuropathy A 19 year-old female patient has begun therapy with Atripla. This medication contains tenofovir. Which of the following statements concerning tenofovir is correct? - ANSWER Tenofovir can damage the kidneys and it requires a reduced dosage with renal insufficiency. It can cause Fanconi syndrome, weaken bone, and can damage kidneys; it is necessary to monitor renal function when using this drug. Manuel is admitted to the orthopedic unit with an infected toe. The toe is amputated. The surgeon reports that he is not sure how far up the bone the infection has spread.