G. R. is a 47-yr. old female who was seen in your primary care clinic for her annual exam 2 months ago. At that time she was upset because she believed her husband had been unfaithful. G.R. stated that she cried frequently and felt “down.” Counseling was recommended, and because she agreed, she was referred for counseling. Her physical exam and labs (Pap smear, STD testing, Hgb/Hct, and UA) were all within normal limits at that visit. Today, she tells you that she did not go to her counseling appointment, because she thought she could handle her problems herself. She and her husband are currently “trying to work things out.” However, she continues to have frequent episodes of crying “for no reason,” and she worries about her marital problems frequently. She also complains about being “tired all the time” with a lack of energy every day. These symptoms are beginning to impact her work. She frequently wakes at 3-4 am and has trouble returning to sleep. She also has a few occasions when she feels “anxious.” She denies any suicidal ideation.    Her current meds are: Alesse for contraception (has been on for 5 years) and an OTC multi-vitamin. She denies using tobacco, alcohol or street drugs. Her physical exam, (including vital signs) is unremarkable except that her affect is unanimated and she appears sad.  You diagnose depression with some anxiety symptoms. After reviewing the information in the case. Which statement best describes the drug problem?

Which of the following diabetes medications is/are least likely to cause hypoglycemia when used as monotherapy because if their mechanism of action? 

Matching Question-UTI

Frances T. is a 39-year-old female who has recently moved to your town. She has selected you as her new primary care provider, and she is here for her annual exam. She is on monophasic estrogen/progestin OCP for contraception, which she has used without problems for 10 years; she would like the prescription renewed. She tells you that she tried a diaphragm once but didn’t like it because it was a difficult and “messy” to use; does not want to use other barrier methods for similar reasons. She was divorced 1 year ago, and has had 4 different sexual partners since then. She rarely uses condoms. She was put on Augmentin 3 days ago, by a physician at the local urgent care center, for an infected laceration on her hand.  PMH: Appendectomy at age 4 yr. No other major medical/surgical problems. Family Hx: Paternal GF — COPD & lung Ca; Paternal GM — arthritis & stroke; Maternal GM — goiter; Father — COPD; Mother — hypothyroid; 2 maternal aunts — hypothyroid; negative for heart disease, reproductive or breast Ca. Social: Smokes 1 1/2 packs of cigarettes per day for past 15 years; has tried to quit two different times without success.  Current Medications: Lo/Ovral  — one qd  Augmentin — 500 mg tid (7 days of medication left)  VS: BP 120/72; P80; Temp 97.8 F; Wt. 135 lb; Ht. 5′ 5″ Physical Exam: Unremarkable except laceration on left hand which is healing with small area of redness but no swelling, purulent drainage or increased warmth. Pap smear and STD testing were performed. Are there any drug-related problems in this case? Please mark all that apply to this case.

A client recently diagnosed with ADHD presents to your clinic with documentation regarding the recent diagnosis. You recommend to start on a medication that the FDA approved for use in treatment of ADHD and that is not a controlled substance. Which medication do you prescribe?

Absolute contraindication to estrogen therapy include:  

Which of the following are the most appropriate, evidence-based, topical medications to recommend for the treatment of osteoarthritis? (Select all that apply).

Li is a 6-month-old infant with severe atopic dermatitis.  Symptoms started with small patches on the elbows and knees about 3 weeks ago and continue to spread to about 25% of her body. You determine she would benefit from topical corticosteroid therapy. The instructions/education you provide Li’s guardians regarding safe use of topical corticosteroids in children include:  

B.H. is a 39 yo male who presents via a virtual visit today with concerns for a rash. After you evaluate the rash, you conclude it is likely contact dermatitis s/p exposure to poison ivy. The rash is on the ventral aspects of the lower forearms bilaterally, covering about 50% of the arms and new spots erupting on the face and has been present for 5-7 days and continues to spread. You would consider use of oral corticosteroids in treatment of contact dermatitis when:

B.R. returns to clinic several months for follow-up on his diabetes. (His epigastric symptoms have resolved with your previous therapy.) His home blood glucoses the past 3 months have been running 200 – 250. He states he has been taking his metformin and had not missed any doses. Also states that his diet has not changed. He walks for exercise for 20 – 30 minutes 3 – 4 times per week. Continues on the same routine medications.  VS: BP 124/78; P 70; Wt. 164 lb; Ht. 5’10” Physical exam: Normal except for decreased sensation – both feet. Labs today: Chem profile – Electrolytes within normal limits; Serum Cr – 1 mg/dl; BUN — 10 mg/dl; glucose of 220 (random); HbgA1c – 9.4   13. What best describes his drug problem today?