Urgent Care Urgent Care Medications and Prescribing 2 — Questions and Answers
Question 1: A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole (TMP-SMX) for a UTI. What is the key concern?
- TMP-SMX reduces warfarin absorption
- TMP-SMX inhibits CYP2C9, raising INR and increasing bleeding risk (Correct answer)
- TMP-SMX has no interaction with warfarin
- TMP-SMX decreases anticoagulation effect of warfarin
Correct answer: TMP-SMX inhibits CYP2C9, raising INR and increasing bleeding risk
TMP-SMX inhibits CYP2C9, reducing warfarin metabolism and significantly elevating INR, which increases the risk of major bleeding.
Question 2: Which medication is contraindicated in a pregnant patient presenting with a UTI?
- Amoxicillin
- Nitrofurantoin in the first trimester
- Cephalexin
- Trimethoprim-sulfamethoxazole in the third trimester (Correct answer)
Correct answer: Trimethoprim-sulfamethoxazole in the third trimester
TMP-SMX is contraindicated near term (third trimester) due to the risk of neonatal hyperbilirubinemia and kernicterus.
Question 3: What is the correct prescribing approach to avoid antibiotic resistance when treating mild skin infections in urgent care?
- Prescribe the broadest spectrum antibiotic available
- Use the narrowest spectrum effective antibiotic for the shortest appropriate duration (Correct answer)
- Always prescribe two antibiotics concurrently
- Avoid antibiotics entirely and rely on incision and drainage
Correct answer: Use the narrowest spectrum effective antibiotic for the shortest appropriate duration
Antibiotic stewardship principles support using the narrowest effective spectrum for the shortest appropriate duration to minimize resistance.
Question 4: A patient with type 2 diabetes is started on a fluoroquinolone antibiotic. What glucose monitoring instruction should be given?
- Fluoroquinolones have no effect on blood sugar
- Monitor glucose closely — fluoroquinolones can cause both hypoglycemia and hyperglycemia (Correct answer)
- Increase insulin dose by 20% preventively
- Stop all diabetes medications while taking fluoroquinolones
Correct answer: Monitor glucose closely — fluoroquinolones can cause both hypoglycemia and hyperglycemia
Fluoroquinolones can cause unpredictable dysglycemia (both hypo- and hyperglycemia) in diabetic patients, requiring close glucose monitoring.
Question 5: Which of the following is the appropriate first-line topical treatment for impetigo in urgent care?
- Topical mupirocin (Bactroban) twice daily for 5 days (Correct answer)
- Topical hydrocortisone cream
- Topical antifungal cream
- Topical silver sulfadiazine
Correct answer: Topical mupirocin (Bactroban) twice daily for 5 days
Topical mupirocin applied twice daily for 5 days is the recommended first-line treatment for limited, localized impetigo.
Question 6: When prescribing a benzodiazepine for acute muscle spasm in urgent care, what is the most important patient instruction?
- Take with food to increase absorption
- Do not drive or operate machinery; avoid alcohol; use for no more than 3–5 days (Correct answer)
- Increase dose if pain is not controlled after 24 hours
- Take with an NSAID for additive effect only
Correct answer: Do not drive or operate machinery; avoid alcohol; use for no more than 3–5 days
Benzodiazepines cause CNS depression — patients must avoid driving, alcohol, and limit use to the shortest possible duration to minimize dependence and accident risk.
Urgent Care Urgent Care Medications and Prescribing 2
A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole (TMP-SMX) for a UTI.
What is the key concern?