An 11-year-old boy with ADHD is started on amphetamine-dextroamphetamine XR after inadequate response to behavioral therapy alone. His past medical history is unremarkable, and family history is negative for congenital heart disease or sudden cardiac death. At baseline, his BP is 100/62 mmHg and HR is 84 bpm. The NP counsels his parents on adverse effects that require ongoing monitoring. Which cardiovascular risk is most important to assess during follow-up visits? 

A 62-year-old with hypertension and CAD is started on propranolol. Shortly after, he reports new wheezing and SOB. What is the best explanation? 

A 45-year-old man with a 20-year history of heavy alcohol use (one pint of whiskey daily) presents 12 hours after his last drink with tremors, diaphoresis, anxiety, nausea, tachycardia, and hypertension. His CIWA score is 18, indicating moderate withdrawal. He is alert and oriented without hallucinations or seizures. Which pharmacologic therapy is most appropriate to initiate at this time? 

A 39-year-old with bipolar disorder is stable on lithium. Labs show creatinine 2.0 mg/dL. What is the most appropriate action? 

A 72-year-old woman with hypertension and osteoarthritis is prescribed digoxin. Her renal function shows eGFR 28 mL/min. What adjustment is most critical? 

A 32-year-old man with no prior cardiac history is brought to the ED after using cocaine at a party. He reports severe substernal chest pain, palpitations, and anxiety. Vitals: BP 182/102 mmHg, HR 128, RR 22. Exam shows diaphoresis and pupillary dilation. EKG demonstrates sinus tachycardia. Troponin is mildly elevated. Which pharmacologic management is most appropriate at this time? 

Which lab monitoring is essential for patients on lithium? 

A patient overdoses on amitriptyline. Which complication is most life-threatening? 

Which drug type requires especially close therapeutic monitoring? 

A 58-year-old man with a long history of alcohol use disorder is brought to the ED by his family for confusion, unsteady gait, and abnormal eye movements. On exam, he is disoriented to time, demonstrates a wide-based ataxic gait, and has bilateral lateral rectus palsy. Vitals are stable. Labs show mild macrocytic anemia and elevated AST > ALT. The NP suspects Wernicke’s encephalopathy. Which is the most appropriate immediate intervention?