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Sheila B. age 30 presents to the clinic with complaint of classic migraine headache, which she describes as moderately severe. She first developed migraines in her teen years and they have worsened as she has gotten older. She has been using ibuprofen, aspirin, acetaminophen and aspirin plus caffeine 2 to 3 times per week for the treatment of her headaches, but continues to experience them despite increasing therapy. The best course-of-action from the list below to manage Sheila’s headaches is:

Question 11:  A patient taking Lisinopril (an ACE inhibitor) would need to be monitored carefully if taking the following supplement (select one):

Use the following case study to answer questions 17 and 18.  Lois, age 54, is taking warfarin (Vitamin K antagonist, an anticoagulant) 4 mg p.o. each day following a deep vein thrombosis. Her INRs have been well-maintained at 2.0 – 2.3. Today, however, her INR is 4.8. On review of her history, you note that she has been taking Advil Cold (Ibuprofen, an NSAID + phenylephrine, a decongestant), an over-the-counter cold remedy regularly for the past 3 days.  Other daily medications include atorvastatin (statin) 20mg  and lisinopril (ACE-I) 10mg. She has been on these daily medications and dosages  for several years. A careful history, physical exam, and diagnostic testing reveal no evidence of active bleeding. Given what you know about drug-drug interactions with warfarin (Vitamin K antagonist) and management of elevated INRs, identify appropriate actions to take with this patient.  (Choose as many of the following options as apply). 

Question 3: When using oral steroids to treat an asthma exacerbation, the following is TRUE:

Question 9: George is a 55 year-old Caucasian male who is a Type II Diabetic. He is hypertensive and her BP has not been responsive to lifestyle and dietary changes. His glucose control is variable. The antihypertensive class of medications that has shown specific benefit to patients with diabetes and protective of renal function is:

The drug used to treat acne that is absolutely contraindicated in pregnant women is:

Patients on oral bisphosphonate therapy for osteoporosis should be instructed to:

Question 8: Ella, age 64 presents to the clinic for blood pressure (BP) follow up. Her BP today is 138/88. You notice that she has consistently run in the high 130s systolic over high 80s diastolic for the past 1 year.  She is a 30 pack year smoker and overweight. She was recently started on a statin medication for hyperlipidemia. Her atherosclerotic cardiovascular risk (ASCVD) is 12%. Best action to take at this time is:

Triptans with an NSAID are more effective than using either drug alone

Question 24 Match the drug/drug class with potential serious side effect.