Which medication would be considered “First-Line” in treating Fibromyalgia associated pain?

Which antidepressant should be avoided in Elderly patients (>65 years of age)?

You determine you are going to admit John to a general care floor for close monitoring and you are writing his admission orders. 1.) List what medications you will order for him at this point to treat his heart failure and explain why you are ordering them.  2.) Looking at his list of home medications determine which you will continue in the hospital and which you will hold. Describe why. Medications at home are: Amlodipine 5 mg daily, Simvastatin 20 mg daily, Metformin 500 mg BID, and Naprosyn.   He has recently refilled his medications and generally takes as prescribed.

D.C. is a 24 year old female patient is admitted to your facility after being diagnosed with an asthma exacerbation. She has a history of obesity and GERD. She is allergic to Sulfa drugs and cat dandruff. She has had 2 weeks of progressive dyspnea, wheezing, and cough. She only has a rescue inhaler at home. She was diagnosed with asthma as a child and had been controlled without needing additional treatment until one year ago. Since then, she has been hospitalized for asthma exacerbation three times in the last six months. At one point, she required non-invasive ventilation. She has been lost to follow-up due to financial constraints so she has yet to see a pulmonologist as an adult. She came to the hospital because she couldn’t catch her breath and this is the worst it’s been since the last admission. During your exam, D.C is on 3 L NC with SpO2 94%. BP 137/68, HR 117, Temp 98.3F, and RR 24. Labs unremarkable. CXR negative for acute cardiopulmonary process. She has a dry cough and continues to have bilateral expiratory wheezing but it has improved since admission. She reports episodic flares approximately 3-4 times a month mostly at night and states that she has “just been dealing with it” and using her rescue inhaler.  Following your exam, you complete spirometry testing which shows a FVC (forced vital capacity) of 68% and FEV1 (forced expiratory volume in 1 second) of 73% predicted. Based on the information provided, answer the following questions. 

John is a 66 year old male who presented to the emergency department with new onset shortness of breath which began two weeks ago but has worsened over the last 24 hours. He has slept sitting up on the sofa for the past two nights. He denies chest pain or tightness, fever or chills, and had no recent sick contacts. He reports his legs have some new “swelling” and his shoes are too tight. His PMH includes HTN, Diabetes, hyperlipidemia and arthritis Medications at home are: Amlodipine 5 mg daily, Simvastatin 20 mg daily, Metformin 500 mg BID, and Naprosyn.   He has recently refilled his medications and generally takes as prescribed. You are the NP working on the internal medicine service and you get called to evaluate John. On exam you find he is awake, alert and oriented. You note he was markedly dyspneic when he ambulated 20 feet, but after returning to a chair, he is breathing comfortably at rest. His neck veins are distended. His heart rate is regular. His lungs are generally clear bilaterally but you note they are decreased at the bases. His extremities are warm but he has +2 bilateral pedal and pre-tibial pitting edema. Vital signs are: Temp 97.7, HR 98, RR 26, BP 159/82  

Dale is charged with assault in California Superior Court for a fight between him and Val in the parking lot after a sporting event.  Both Val and Dale were taken to the hospital for injuries related to the incident. While police were assessing Val’s injuries and securing the scene Val shouted “Dale attacked me first!”  Later that evening, at the hospital, Val gave a statement to a detective describing the incident in detail, again stating that Dale was the aggressor.  The detective conducted the interview as part of an ongoing investigation. Val later died from unrelated causes before trial. At trial, the prosecution offers [1] the police report containing Val’s statement at the scene and [2] the testimony of the detective who took Val’s statement at the hospital. The prosecution also offers: [3] a hospital report prepared shortly after the incident describing Dale’s injuries and stating that “Patient reports injury on hand was caused by hitting bystander multiple times while intoxicated.”  The treating doctor is unavailable. Dale calls [4] Walter, Val’s ex boyfriend, to testify that in his opinion “Val is a violent person and he saw her start fights almost every time they went out over the two years they were dating.” Discuss all evidentiary issues raised by the items at [1] through [4] above. Answer according to the California Evidence Code.

You find a four-legged animal on the shore of a pond. It has a backbone, and can breathe through its skin, but also has lungs. Its eggs are thin-walled and must be laid in the water. This organism is…

Final Exam password: done!

A species of fish can have colors ranging from light to dark, depending on their genotype. At first, the fish in a lake are mostly light-colored. However, the water gets darkened by pollution, so darker fish are now better at hiding from predators. Does this situation meet the requirements for natural selection? In your explanation, say which requirements it meets or does not meet (2-3 sentences, 3 pts.) Someone claims: “Pollution makes fish mutate in order to blend in. When a fish mutates to adapt, it passes that mutation down to its offspring.” That claim is FALSE! Explain what is wrong with it, using the terms selection, mutation, random, and non-random correctly in your answer. (3 pts)

After Philip was publicly assassinated, this 19 year old son took over as king, blamed the Persians for his murder, and led the invasion of Asia himself