Kern, 72-year-old male presented at the hospital complaining of severe pain in his left leg, shortness of breath, and pleuritic type chest pain following a long drive from Connecticut to Florida with minimal stopping. The patient had a history of pulmonary embolism, degenerative joint disease, and previously was a chronic smoker. His vital signs were: temperature 38.4 °C, pulse 98 bpm, respiratory rate 20 breaths per minute, and blood pressure 138/90 mm Hg. Basic metabolic panel and complete blood count values were within the normal range. Kern is  diagnosed with a new DVT. Kern is given an appropriate loading dose (bolus) of heparin (Half-Life ≈ 1.5 hrs) and started on a heparin infusion at an initial rate of 18 units/kg/hr. Six hours after starting the initial infusion, Kern’s aPTT is 37 seconds. (Institution-specific therapeutic range is 46-70 seconds). What should be done?

Which medication is considered to be the drug of choice for children with acute otitis media? Assume no drug allergies or recent antibiotic therapy.

Josina is a 65 yo AA woman who presents to clinic feeling tired for the last 3 months.  She is able to complete some light housework and cook her dinners, but she has difficulty breathing when doing more activity such as grocery shopping and walking up stairs.  She sleeps on 2 pillows at night to help with her breathing. PMH:  Heart failure with reduced ejection fraction (class III, stage C) HTN, arthritis. Physical exam: Edema of her feet and ankles (2+) with some crackles noted in the lungs on inspiration Medications:  HCTZ (Hydrodiuril*) 12.5mg daily, and ibuprofen (Motrin* / Advil*) 200mg BID for arthritis in knee. Vitals:  height 5’2″, 63kg, BP 134/84, HR 78, EF 35% per echocardiogram.  Which of the following is most appropriate regarding diuretic therapy for Josina?

Mr. Damone, a 59 year old man, presents to the emergency department with crushing chest discomfort. An ECG indicates a small transmural left ventricular free wall infarction. The patient is given several drugs, for both immediate management of ischemia and for long term prevention of a subsequent MI. Which of the following drugs would provide immediate relief of the symptoms of myocardial ischemia, but has no long term effects on mortality (i.e. reducing the risk of sudden cardiac death or ventricular dysfunction)?

A patient is prescribed his first prescription for allopurinol (Zyloprim*). Which statement below is NOT correct regarding this medication?

An absolute contraindication to the use of triptans would be :

The ID physician on your floor comments that your patient has a virulent pathogen that is not resistant to antibiotics.  What does this mean?

A 45-year-old female presents to the clinic with complaints of severe pain in her lower back, radiating down her left leg. She describes the pain as burning and shooting, with occasional numbness and tingling. Physical examination reveals decreased sensation in the left L5 dermatome and diminished reflexes in the left lower extremity. Based on these findings, the nurse practitioner suspects lumbar radiculopathy. Which of the following medications would be the most effective for managing the patient’s neuropathic pain?

Which of the following medication (s) is a xanthine oxidase inhibitor and can therefore be beneficial in hyperuricemia?

The use of metoprolol (Lopressor* / Toprol XL*), a cardioselective (also known as β1 selective) beta blocker, is absolutely contraindicated in patients with COPD (or asthma) despite any possible compelling indications (e.g. stable heart failure or IHD).