A 58-year-old male with a history of gout presents to the clinic complaining of sudden-onset severe pain, redness, and swelling in his left big toe. He reports similar episodes in the past and suspects another gout flare. Based on the ACR guideline recommendation for early management of acute gout flares, which of the following medications would NOT be included in the “medication-in-pocket” strategy for this patient?

The Spillover Effect relates to how challenges in family and work life are not interconnected.

Culturally responsive wellness strategies enhance belonging, resilience, and sense of coherence.

A 45-year-old female presents to the clinic with complaints of persistent joint pain and swelling in her hands consistent with rheumatoid arthritis. She has a history of intermittent use of over-the-counter ibuprofen for pain relief but reports inadequate symptom control. Based on the information provided, what is the minimal duration that should be considered an adequate trial of oral NSAID therapy for this patient?

A 45-year-old female presents to the clinic with a history of recurrent migraines. She reports experiencing throbbing headaches associated with nausea, photophobia, and phonophobia, occurring approximately twice a month and lasting for 24-48 hours. Despite trying over-the-counter medications, she finds little relief from her symptoms. Given her history, the nurse practitioner decides to initiate prophylactic therapy for migraine prevention. Which of the following medications might not be the best choice (i.e., relative contraindication) in this patient due to comorbid reactive airway disease (i.e., severe asthma)? 

Which of the following medicatons has been associated with a high risk of developing a clostridium difficile (C. diff) infection?

A 71-year-old woman comes into the ED complaining of exertional chest pain. She currently takes atenolol (Tenormin*) 50 mg PO daily, amlodipine (Norvasc*) 5 mg PO daily, ramipril (Altace*) 10 mg PO daily, aspirin (Bayer Baby Aspirin*) 81 mg PO daily, and rosuvastatin (Creastor*) 10 mg PO daily. Which monitoring parameters are needed for you to make a recommendation to relieve her angina symptoms? 

JP is a 17-year-old male who complains of redness, tenderness and warmth of his left lower leg which has been spreading for the past 3 days.  From your questioning, you discover JP has a recent spider bite in the same area but it never seemed to heal.  You suspect that JP has an uncomplicated cellulitis since the infection appears to be localized and JP does not have signs/symptoms of systemic infection.  JP has a history of hypothyroidism and obesity.  He currently takes levothyroxine (Synthroid) 50 mcg po daily.  He has no medication allergies. UPDATES: Upon further questioning of JP’s mother, you find out that he is a football player and she noticed his leg infection began shortly after football camp.  She seemed to think the spider bite was small and healing until he went to camp. You suspect he may have a CA-MRSA cellulitis. Which of the following medications would be the best choice to treat this mild CA-MRSA cellulitis?

A 55-year-old male presents to the clinic with complaints of sudden onset severe pain, erythema, and swelling in his right big toe joint. Based on the presenting symptoms, the nurse practitioner suspects an acute gout attack. Which of the following statements regarding the diagnosis of gout is true?

NJ is receiving 40 mg po morphine/day.  You wish to convert him to po oxycodone (Oxy IR).  Which of the following regimens is the best recommendation for this patient?   Assume a 25% reduction for incomplete cross tolerance.  The following conversions are provided for you:   Drug IV (mg) Oral (mg) Morphine 10 30 Oxycodone N/A 20