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Hard to choose

Posted

Specializes in Wiping tears. Has 3 years experience.

I have been practicing exams since the beginning of my RN program. But, this question, for some reason, I don't understand the reasoning behind it since they are all need to be followed-up. For me, they are medications that need to be followed-up. I need someone to help me with this. Please dumb down.  I picked the "Glipizide." And the correct answer is Lisinopril. 

Here is the question: "The nurse is preparing discharge resources for a client being discharged to the homeless shelter. When looking at the discharge medication reconciliation form, the nurse determines there is a need for follow-up if which medication was prescribed?"

Choices are: 

1. Glipizide

 2. Lisinopril

 3. Metformin

 4. Beclomethasone


Source: https://coursewareobjects.elsevier.com/objects/elr/Silvestri/comprehensiveRN8e/examreview/

Edited by ThursdayNight

I do think it is kind of a poor question, but there is probably one better answer in some ways (lisinopril).

Can you give your rationale for choosing glipizide, or did you guess?

Can you come up with the reason they have likely provided lisinopril as the correct answer?

I would work through this by reading about what needs to be monitored with each of these meds, how soon/often it needs to be monitored and the kind of consequences that might arise if there is a problem.

Will check back later....

 

ThursdayNight, CNA

Specializes in Wiping tears. Has 3 years experience.

19 hours ago, JKL33 said:

I do think it is kind of a poor question, but there is probably one better answer in some ways (lisinopril).

Can you give your rationale for choosing glipizide, or did you guess?

Can you come up with the reason they have likely provided lisinopril as the correct answer?

I would work through this by reading about what needs to be monitored with each of these meds, how soon/often it needs to be monitored and the kind of consequences that might arise if there is a problem.

Will check back later....

 

I picked my answer was according to its level of danger. Glipizide is a high alert, overdose can quickly send a person to hypoglycemic, and is interacting with alcohol.

Lisinopril treats HTN and HF but not a high alert medication. The person gets dehydration, overdose, and/or taking other drugs may potentiate effects that lead to hypotension but not as dangerous as the glipizide when there is medication error.

Metformin is also a DM med but not high alert medication but not as dangerous as the glipizide.

Beclomethasone is not a high alert medication and is not as dangerous as glipizide. 

That's what I can think of. 

They'll do interact with alcohol but glipizide is the worst medication than those 3 drugs.

Edited by ThursdayNight

ThursdayNight, CNA

Specializes in Wiping tears. Has 3 years experience.

19 hours ago, JKL33 said:

I do think it is kind of a poor question, but there is probably one better answer in some ways (lisinopril).

Can you give your rationale for choosing glipizide, or did you guess?  

I already have a little bit of knowledge of diabetic medications, but I have to grow up more. 
 

You posted some good thoughts.

It can be really difficult to know what is important, what applies and what the question is trying to ask. I believe it's probably best to answer as if everything goes routinely with the use of the medication.

One of these medications requires a specific follow-up even if the medication is used as intended, there is no overdosing or use of alcohol, etc.

I feel for you because I certainly think that a person with few resources such as a homeless person should be followed up if they are given new prescriptions for diabetic medications or antihypertensives. Well, any patient should, for that matter. It's not a great question.

I believe they are getting at something particular. Don't base it off whether or not your particular facility or reference book calls the medications "high risk." Review your information on lisinopril. See if there's anything they are saying needs to be monitored (besides blood pressure).

Good work. I'll be back later...👍🏽

amoLucia

Specializes in LTC.

OP - I LOVE LOVE LOVE this question!!

I laughed when I first read it, thinking how  does a homeless person afford those meds?!?!!?! But then I started to think about it. Even though I retired 10 yrs ago after 36 years active nsg, I love posts like this that challenge my curiosity. I love learning new things. You DID give away the answer as lisinopril, so then I tried to figure out why. So ...

#1 - both metformin and glipizide are ORAL diabetic meds, so my belief is that that disease process must NOT be as terrible as it could possibly be. And the fact that 2 meds are being used, says the process is being addressed by a practitioner who prescribes.

#2 - beclomethasone. Anything ending in 'SONE' just screams STEROID, and in this case corticosteroid. In my personal opinion, I believe the class of steroids are more potent and more impacting on health than opioids!  I know from gen'l knowledge that STEROIDS have such an influence to cause or exacerbate other serious medical conditions. So .... I'm believing that the beclomethasone has contributed to the diabetes - so to me, it's a 'given' that the bec'sone was associated with the diabetes.

**** In ref to your query, I am ASSUMING that the test author also assumed or acknowledged that the diab was assoc with bec'sone's use.

In my short readings, I did read that bec'sone has potential to inhibit the pancreas in its role with insulin. So definitely, TO ME, those 3 meds are connected.

#3 - lisinopril. This says cardiac, be it MI, CHF, HTN, etc.

I guess my whole answer to your question was my connecting the 3 drugs, and then questioning why lisinopril was NOT connected. Endocrinology and pulmonary systems are being address, so strong attn to cardiology seems VERY appropriate.

Lisinopril is a potent drug - beta blockers & -ace inhibtors are NOT to be underestimated.  Lisinopril does have a negative effect on renal pathology; so nephrology is also indicated. It's other side-effects are also serious, so more pt education is appropriate. As well as cardiac disease diagnostic etiologies.

Personally, I do see lisinopril as the drug needing the most intense attn. Just thru the processes of elimination & association. Don't know if others here would agree with my logic.

(But that's my story, and I'm sticking to it!)  ;)))

ThursdayNight, CNA

Specializes in Wiping tears. Has 3 years experience.

58 minutes ago, amoLucia said:

OP - I LOVE LOVE LOVE this question!!

I laughed when I first read it, thinking how  does a homeless person afford those meds?!?!!?! But then I started to think about it. Even though I retired 10 yrs ago after 36 years active nsg, I love posts like this that challenge my curiosity. I love learning new things. You DID give away the answer as lisinopril, so then I tried to figure out why. So ...

#1 - both metformin and glipizide are ORAL diabetic meds, so my belief is that that disease process must NOT be as terrible as it could possibly be. And the fact that 2 meds are being used, says the process is being addressed by a practitioner who prescribes.

#2 - beclomethasone. Anything ending in 'SONE' just screams STEROID, and in this case corticosteroid. In my personal opinion, I believe the class of steroids are more potent and more impacting on health than opioids!  I know from gen'l knowledge that STEROIDS have such an influence to cause or exacerbate other serious medical conditions. So .... I'm believing that the beclomethasone has contributed to the diabetes - so to me, it's a 'given' that the bec'sone was associated with the diabetes.

**** In ref to your query, I am ASSUMING that the test author also assumed or acknowledged that the diab was assoc with bec'sone's use.

In my short readings, I did read that bec'sone has potential to inhibit the pancreas in its role with insulin. So definitely, TO ME, those 3 meds are connected.

#3 - lisinopril. This says cardiac, be it MI, CHF, HTN, etc.

I guess my whole answer to your question was my connecting the 3 drugs, and then questioning why lisinopril was NOT connected. Endocrinology and pulmonary systems are being address, so strong attn to cardiology seems VERY appropriate.

Lisinopril is a potent drug - beta blockers & -ace inhibtors are NOT to be underestimated.  Lisinopril does have a negative effect on renal pathology; so nephrology is also indicated. It's other side-effects are also serious, so more pt education is appropriate. As well as cardiac disease diagnostic etiologies.

Personally, I do see lisinopril as the drug needing the most intense attn. Just thru the processes of elimination & association. Don't know if others here would agree with my logic.

(But that's my story, and I'm sticking to it!)  ;)))

I understand this better. The rationales given in Saunders didn't make sense to me. 

Thank you. 

Well, my answer is that when beginning ACEIs like lisinopril the patient should have follow-up labs, metabolic panel specifically. A couple of main reasons are to keep track of kidney function (Creatinine and GFR, etc) and because ACEIs can overall decrease aldosterone which can lead to less potassium excretion and sometimes cause hyperkalemia.

ThursdayNight, CNA

Specializes in Wiping tears. Has 3 years experience.

Just now, JKL33 said:

Well, my answer is that when beginning ACEIs like lisinopril the patient should have follow-up labs, metabolic panel specifically. A couple of main reasons are to keep track of kidney function (Creatinine and GFR, etc) and because ACEIs can overall decrease aldosterone which can lead to less potassium excretion and sometimes cause hyperkalemia.

I was just learning about high and low potassium + kidneys and lungs.

Thank you. 

amoLucia

Specializes in LTC.

OP - I glad my thinking out loud has helped. Of course, it also helped that I knew the correct answer to be lisinopril in advance. But after years of experience, some things just jump out at you. Like for your future, always look at -sone drugs like they're waving a red flag at you. STEROIDS!

And even though bec'sone is a commonly prescribed inhaler, it's still is a steroid. I know I feel the difference about 5 minutes after my 2 puffs.  Inhalers can be serious business! Never take them for granted, even though 'it's only a puffer'!

Likewise, I had past experience with lisinopril significantly affecting my creatinine level and sending me to a nephrologist ASAP. After being off it for 2 yrs with decent levels, it was restarted on the lowest dose. (I was post-silent MI with current CHF issues.) Knowing what I do, I know the serious renal implications so I had to keep fighting to get labs drawn, and finally ... My creatinine is higher than my last draw. Am really going to be watching it. As will cardiology and PMP.

Just thought of this post again as I puffed my puffer HS dose. Also had to refill my medi-set pill box and had to add in my lisinopril.