1. A 28-year-old female presents with a 3-day history of dysuria, frequency, and urgency. Urinalysis reveals positive leukocyte esterase, nitrites, and >100,000 CFU/mL E. coli. She has no fever or flank pain. She reports a penicillin allergy (rash). What is the most appropriate initial antibiotic for this uncomplicated urinary tract infection (UTI)?
Evaluation
A.Nitrofurantoin
B.Ciprofloxacin
C.Amoxicillin-clavulanate
D.Trimethoprim-sulfamethoxazole (TMP-SMX)
Show answerAnswer
A. Nitrofurantoin
Nitrofurantoin is a first-line agent for uncomplicated UTIs due to its excellent efficacy against common uropathogens like E. coli and its low resistance rates. It is also safe in penicillin-allergic patients.
2. A 62-year-old male with chronic kidney disease (CKD) Stage 3 is prescribed lisinopril for hypertension. His baseline creatinine was 1.5 mg/dL with an eGFR of 45 mL/min/1.73m². One week after starting lisinopril, his creatinine is 1.8 mg/dL and eGFR is 38 mL/min/1.73m². He reports no new symptoms. What is the most appropriate action?
Evaluation
A.Continue lisinopril and recheck renal function in 2-4 weeks.
B.Add a loop diuretic to counteract the renal effect.
C.Discontinue lisinopril immediately.
D.Decrease the dose of lisinopril by 50%.
Show answerAnswer
A. Continue lisinopril and recheck renal function in 2-4 weeks.
A small, stable increase in creatinine (up to 30% above baseline) is expected and acceptable when initiating an ACE inhibitor or ARB in patients with CKD, as it reflects the drug's beneficial hemodynamic effects on the kidney. Discontinuation is usually reserved for larger or progressive increases.
3. A 58-year-old female with a history of hypertension and osteoarthritis is prescribed ibuprofen 600 mg three times daily for acute knee pain. She presents for follow-up reporting worsening edema in her ankles and her blood pressure is now consistently elevated at 150/90 mmHg. Which of the following is the most appropriate initial modification to her treatment plan?
Evaluation
A.Advise her to elevate her legs and reduce sodium intake.
B.Discontinue ibuprofen and consider an alternative analgesic.
C.Add a diuretic to her medication regimen.
D.Increase the dose of her current antihypertensive medication.
Show answerAnswer
B. Discontinue ibuprofen and consider an alternative analgesic.
NSAIDs like ibuprofen can cause fluid retention and elevate blood pressure, especially in patients with pre-existing hypertension. Discontinuing the NSAID is the most appropriate initial step to address these side effects.
4. An FNP is reviewing quality improvement data for their clinic related to hypertension management. They notice that only 60% of patients with hypertension have achieved their target blood pressure of <140/90 mmHg. Which of the following is the most appropriate initial step in a quality improvement (QI) initiative to address this outcome?
Evaluation
A.Increase the number of FNP appointments for hypertensive patients.
B.Mandate all clinic staff attend a hypertension management seminar.
C.Conduct a root cause analysis to identify barriers to BP control.
D.Implement a new electronic health record (EHR) system.
Show answerAnswer
C. Conduct a root cause analysis to identify barriers to BP control.
Before implementing solutions, it is crucial to understand why the current outcomes are suboptimal. A root cause analysis will systematically identify underlying factors contributing to the low percentage of patients achieving target blood pressure, allowing for targeted and effective interventions.
5. A 75-year-old female with osteoarthritis is taking celecoxib 200 mg daily. She has a history of hypertension and well-controlled Type 2 Diabetes. During her annual physical, her FNP notes her blood pressure is 150/92 mmHg, and she has 1+ pedal edema. Her previous BP was 130/80 mmHg. What is the most likely cause of her elevated blood pressure and edema?
Evaluation
A.Adverse effect of celecoxib.
B.Worsening osteoarthritis leading to reduced mobility.
C.Non-adherence to her antihypertensive medication.
D.Progression of Type 2 Diabetes causing nephropathy.
Show answerAnswer
A. Adverse effect of celecoxib.
Non-steroidal anti-inflammatory drugs (NSAIDs) like celecoxib are known to cause fluid retention and elevate blood pressure by inhibiting prostaglandin synthesis, which can lead to vasoconstriction and reduced renal blood flow. Given her recent BP increase and edema, celecoxib is the most likely culprit.
6. A 35-year-old female with a history of anaphylaxis to peanuts is prescribed a new medication for her asthma. After the first dose, she develops generalized urticaria, angioedema, and wheezing. Her blood pressure is 80/40 mmHg. Which of the following is the most immediate and critical intervention?
The patient is experiencing anaphylaxis, characterized by generalized urticaria, angioedema, wheezing, and hypotension. Epinephrine is the first-line and most critical treatment for anaphylaxis, as it rapidly reverses bronchospasm, vasodilation, and angioedema.
7. A 40-year-old female with a history of generalized anxiety disorder (GAD) has been taking sertraline 50 mg daily for 6 weeks. She reports some improvement in her anxiety but still experiences significant worry and muscle tension. Which of the following is the most appropriate next step in her treatment plan?
Evaluation
A.Refer her for cognitive behavioral therapy (CBT) only.
B.Increase the sertraline dose to 75 mg daily.
C.Add a benzodiazepine to her current regimen.
D.Switch to a different antidepressant class, such as a tricyclic antidepressant (TCA).
Show answerAnswer
B. Increase the sertraline dose to 75 mg daily.
After 6 weeks on an initial therapeutic dose of an SSRI for GAD, if there is partial response but not full remission, the next step is typically to titrate the dose upwards. Sertraline has a maximum dose of 200 mg daily, so 75 mg is a reasonable increase.
8. A 60-year-old male with Type 2 Diabetes Mellitus and obesity (BMI 32 kg/m²) is on metformin 1000 mg BID. His A1C is 7.8%, and he has established atherosclerotic cardiovascular disease (ASCVD). What is the most appropriate addition to his current regimen to improve glycemic control and reduce cardiovascular risk?
Evaluation
A.Add empagliflozin.
B.Add pioglitazone.
C.Add glipizide.
D.Add insulin glargine.
Show answerAnswer
A. Add empagliflozin.
For patients with Type 2 Diabetes and established ASCVD, current guidelines recommend adding an SGLT2 inhibitor (like empagliflozin) or a GLP-1 receptor agonist with proven cardiovascular benefits, irrespective of A1C target, to reduce cardiovascular events.
9. A 68-year-old male with a history of heart failure presents for a follow-up visit. He reports increased shortness of breath with exertion, 2+ pitting edema in his ankles, and a 5-pound weight gain over the past week. His current medication regimen includes furosemide 40 mg daily. Which of the following is the most appropriate initial modification to his treatment plan?
Evaluation
A.Schedule for inpatient admission for diuresis.
B.Increase furosemide to 80 mg daily.
C.Initiate lisinopril 5 mg daily.
D.Add spironolactone 25 mg daily.
Show answerAnswer
B. Increase furosemide to 80 mg daily.
The patient is showing clear signs of fluid overload despite being on a diuretic. The most direct and immediate intervention to address this is to increase the dose of his existing loop diuretic, furosemide, to enhance diuresis and reduce fluid retention.
10. A 40-year-old male with new-onset seizure disorder is started on levetiracetam. He is concerned about potential side effects. The FNP should advise him to report which of the following symptoms immediately, as it may indicate a serious adverse reaction?
Evaluation
A.Fatigue
B.Irritability or aggression
C.Mild dizziness
D.Headache
Show answerAnswer
B. Irritability or aggression
Levetiracetam is known to cause psychiatric side effects such as irritability, aggression, agitation, and mood changes, which can be severe and require immediate attention and potential medication adjustment or discontinuation. These are considered serious adverse reactions.
11. A 70-year-old female with a history of recurrent Clostridium difficile infection (CDI) is discharged from the hospital after successful treatment. She is now at high risk for recurrence. What is the most appropriate preventative measure to include in her discharge plan?
Evaluation
A.Prophylactic oral vancomycin for 10 days.
B.Strict adherence to hand hygiene with alcohol-based sanitizers.
C.Extended pulsed or tapered oral vancomycin regimen.
D.Daily probiotic supplementation.
Show answerAnswer
C. Extended pulsed or tapered oral vancomycin regimen.
For patients with recurrent CDI, an extended pulsed or tapered oral vancomycin regimen is the most effective strategy to prevent further recurrences after successful treatment of the acute episode.
12. A 50-year-old female with newly diagnosed fibromyalgia is started on duloxetine 30 mg daily. After 4 weeks, she reports a 20% improvement in pain but continues to have significant fatigue and widespread body aches. She tolerates the medication well. What is the most appropriate next step in her management?
Evaluation
A.Increase duloxetine to 60 mg daily.
B.Add pregabalin 75 mg BID.
C.Switch to amitriptyline 10 mg at bedtime.
D.Refer to a pain specialist for interventional therapies.
Show answerAnswer
A. Increase duloxetine to 60 mg daily.
Duloxetine typically starts at 30 mg daily and can be titrated to 60 mg daily for fibromyalgia. Given her partial response and good tolerance, increasing the dose is the next logical step before adding or switching medications.
13. A 72-year-old male with hypertension and benign prostatic hyperplasia (BPH) is prescribed tamsulosin. He reports feeling dizzy upon standing, particularly in the mornings. His blood pressure is 118/72 mmHg sitting and 98/60 mmHg standing. Which of the following modifications to his treatment plan is most appropriate?
Evaluation
A.Add a low-dose beta-blocker to his regimen.
B.Discontinue tamsulosin and switch to finasteride.
C.Advise him to take tamsulosin at bedtime.
D.Decrease the dose of tamsulosin by half.
Show answerAnswer
C. Advise him to take tamsulosin at bedtime.
Tamsulosin is an alpha-1 blocker that can cause orthostatic hypotension, especially with the first dose or upon standing. Taking it at bedtime can help mitigate the morning dizziness by allowing the body to adjust to the medication's effects during sleep, reducing the risk of symptomatic hypotension when arising.
14. A 68-year-old male with a history of Type 2 Diabetes Mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) is currently on metformin 1000 mg twice daily. His current A1c is 7.8%. He reports no issues with metformin. Which of the following is the most appropriate next step in managing his T2DM?
Evaluation
A.Add glipizide to his current regimen.
B.Initiate basal insulin at bedtime.
C.Increase metformin to 1250 mg twice daily.
D.Add empagliflozin to his current regimen.
Show answerAnswer
D. Add empagliflozin to his current regimen.
For patients with T2DM and established ASCVD, current guidelines recommend adding a GLP-1 receptor agonist or an SGLT2 inhibitor with proven cardiovascular benefit, regardless of A1c, as a second-line agent after metformin. Empagliflozin is an SGLT2 inhibitor with demonstrated cardiovascular benefits.
15. A 40-year-old pregnant patient (G1P0, 28 weeks gestation) presents with new onset gestational hypertension (BP 145/95 mmHg on two occasions, 4 hours apart, no proteinuria). She is otherwise healthy. Which of the following is the most appropriate initial management plan?
Evaluation
A.Recommend strict bed rest at home and daily BP monitoring.
B.Admit for inpatient observation and bed rest.
C.Initiate low-dose aspirin daily and weekly BP checks.
D.Initiate labetalol 100 mg twice daily.
Show answerAnswer
D. Initiate labetalol 100 mg twice daily.
For gestational hypertension with blood pressure consistently at or above 140/90 mmHg, pharmacological treatment is indicated to prevent severe hypertension and its complications. Labetalol is a first-line antihypertensive medication commonly used in pregnancy due to its safety and efficacy profile.
16. A 55-year-old male with newly diagnosed hypertension is started on lisinopril 10 mg daily. After one month, his blood pressure remains 145/92 mmHg. He reports no side effects. What is the most appropriate adjustment to his treatment plan?
Evaluation
A.Refer to cardiology for further evaluation.
B.Add hydrochlorothiazide 12.5 mg daily.
C.Increase lisinopril to 20 mg daily.
D.Switch to amlodipine 5 mg daily.
Show answerAnswer
C. Increase lisinopril to 20 mg daily.
When a patient's blood pressure remains above target on an initial dose of a single antihypertensive medication and they are tolerating it well, the first step is typically to titrate that medication to its maximum effective dose before adding a second agent.
17. A 45-year-old male with Type 2 Diabetes is monitoring his blood glucose levels. His fasting blood glucose readings have consistently been between 130-150 mg/dL over the past two weeks, despite adherence to his current diet and metformin 1000 mg twice daily. His last HbA1c was 7.8% three months ago. Which of the following modifications is most appropriate at this time?
Evaluation
A.Add a sulfonylurea (e.g., glipizide) to his regimen.
B.Initiate basal insulin therapy.
C.Increase metformin to 1500 mg twice daily.
D.Refer to an endocrinologist for advanced diabetes management.
Show answerAnswer
A. Add a sulfonylurea (e.g., glipizide) to his regimen.
The patient's fasting blood glucose and HbA1c indicate that his diabetes is not adequately controlled on metformin monotherapy. According to current guidelines for Type 2 Diabetes management, if HbA1c remains elevated despite maximal tolerated metformin, adding a second oral agent, such as a sulfonylurea, is a common and appropriate next step before considering insulin in most cases.
18. A 58-year-old male with chronic stable angina reports an increase in chest pain frequency and severity over the past month, now occurring with minimal exertion. He is currently taking aspirin, atorvastatin, and metoprolol succinate 50 mg daily. His blood pressure is 130/80 mmHg, and heart rate is 62 bpm. Which of the following is the most appropriate initial modification to his treatment plan?
Evaluation
A.Add sublingual nitroglycerin as needed.
B.Initiate isosorbide mononitrate 30 mg daily.
C.Refer for cardiac catheterization.
D.Increase metoprolol succinate to 100 mg daily.
Show answerAnswer
B. Initiate isosorbide mononitrate 30 mg daily.
The patient's worsening angina despite optimal beta-blocker therapy (heart rate 62 bpm suggests adequate beta-blockade) indicates a need for additional anti-anginal medication. A long-acting nitrate like isosorbide mononitrate is an appropriate next step to reduce anginal symptoms and improve exercise tolerance in stable angina. While sublingual nitroglycerin is for acute relief, the increased frequency and severity warrant a long-acting preventative measure.
19. A 28-year-old female presents with recurrent urinary tract infections (UTIs), experiencing 3 episodes in the past 6 months. She is otherwise healthy. Which of the following is the most appropriate long-term management strategy for preventing future UTIs?
Evaluation
A.Continuous low-dose antibiotic prophylaxis.
B.Increased fluid intake and cranberry supplements only.
C.Referral for surgical evaluation of urinary tract anomalies.
D.Intermittent self-treatment with antibiotics at the first sign of symptoms.
Show answerAnswer
A. Continuous low-dose antibiotic prophylaxis.
For healthy non-pregnant women with recurrent UTIs (≥3 episodes in 12 months or ≥2 in 6 months), continuous low-dose antibiotic prophylaxis is a well-established and effective strategy to reduce recurrence rates. This approach is typically preferred over intermittent self-treatment for long-term prevention.
20. A 65-year-old male with chronic heart failure (CHF) and ejection fraction of 30% is on furosemide 40 mg daily, lisinopril 10 mg daily, and metoprolol succinate 50 mg daily. He reports increasing shortness of breath, 2 lb weight gain over 2 days, and new ankle edema. His blood pressure is 110/70 mmHg, and heart rate is 68 bpm. What is the most appropriate modification to his treatment plan?
Evaluation
A.Discontinue lisinopril due to worsening symptoms.
B.Increase furosemide to 60 mg daily.
C.Add spironolactone 25 mg daily.
D.Increase metoprolol succinate to 75 mg daily.
Show answerAnswer
B. Increase furosemide to 60 mg daily.
The patient's symptoms (shortness of breath, weight gain, edema) are consistent with fluid overload, indicating a need for increased diuretic therapy. Increasing furosemide is the most direct and appropriate intervention.
21. A 50-year-old female with newly diagnosed hypothyroidism is started on levothyroxine 50 mcg daily. She returns for follow-up in 6 weeks. Her TSH is 8.2 mIU/L (reference range 0.4-4.0 mIU/L), and she reports persistent fatigue and weight gain. Which adjustment to her medication is most appropriate?
Evaluation
A.Increase levothyroxine to 75 mcg daily.
B.Switch to a desiccated thyroid extract.
C.Add liothyronine (T3) to her current regimen.
D.Maintain current levothyroxine dose and recheck TSH in 3 months.
Show answerAnswer
A. Increase levothyroxine to 75 mcg daily.
The patient's TSH remains elevated above the target range, indicating that her current levothyroxine dose is insufficient to adequately replace thyroid hormone. The most appropriate next step is to increase the levothyroxine dose and recheck TSH in approximately 6 weeks to assess the response.
22. A 48-year-old female with Type 2 Diabetes Mellitus presents for a follow-up. Her current A1C is 8.2%. She is on metformin 1000 mg BID. She reports consistent medication adherence and dietary modifications. Her renal function is stable. What is the most appropriate next step in her treatment plan?
Evaluation
A.Initiate insulin therapy.
B.Refer to a diabetes educator for dietary review.
C.Add a sulfonylurea to her current regimen.
D.Increase metformin to 1500 mg BID.
Show answerAnswer
C. Add a sulfonylurea to her current regimen.
Given the patient's A1C remains elevated despite maximal metformin dose and reported adherence, the next step is to add a second oral agent. Sulfonylureas are a common and effective second-line therapy.
23. A 30-year-old female presents with symptoms of generalized anxiety disorder (GAD). She has been taking sertraline 50 mg daily for 6 weeks and reports some improvement, but still experiences significant anxiety and interferes with her daily life. She denies side effects. What is the most appropriate next step in her treatment plan?
Evaluation
A.Refer for cognitive behavioral therapy (CBT) only.
B.Add buspirone 5 mg BID.
C.Switch to venlafaxine XR 75 mg daily.
D.Increase sertraline to 75 mg daily.
Show answerAnswer
D. Increase sertraline to 75 mg daily.
For GAD, if a patient has partial response to an SSRI after an adequate trial (typically 4-6 weeks) and tolerates the medication, the dose should be increased to optimize treatment before switching to another agent or adding another medication.
24. A 35-year-old female with newly diagnosed Type 2 Diabetes Mellitus is initiating metformin therapy. She expresses concern about potential side effects. Which of the following is the most important instruction to provide regarding metformin administration to minimize gastrointestinal upset?
Evaluation
A.Take the medication on an empty stomach to improve absorption.
B.Take the medication with a large glass of water only.
C.Avoid consuming dairy products while on metformin.
D.Start with a low dose and gradually titrate up.
Show answerAnswer
D. Start with a low dose and gradually titrate up.
To minimize common gastrointestinal side effects like nausea, diarrhea, and abdominal discomfort when initiating metformin, it is crucial to start with a low dose and gradually increase it over several weeks. This allows the body to adjust to the medication.
25. A 60-year-old male with a history of chronic obstructive pulmonary disease (COPD) is prescribed a new long-acting beta-agonist (LABA) and inhaled corticosteroid (ICS) combination inhaler. He returns for follow-up and reports using his short-acting beta-agonist (SABA) rescue inhaler 4-5 times per week. Which of the following indicates a need for adjustment in his current COPD management?
Evaluation
A.Stable forced expiratory volume in 1 second (FEV1).
B.Improved exercise tolerance.
C.Absence of nocturnal awakenings due to dyspnea.
D.Increased frequency of SABA use.
Show answerAnswer
D. Increased frequency of SABA use.
Increased frequency of SABA rescue inhaler use (more than twice a week, excluding exercise-induced bronchospasm) is a key indicator of inadequate control of COPD symptoms and signals a need to step up or adjust maintenance therapy.
Uncomplicated UTIs in healthy non-pregnant women are typically treated with short courses of antibiotics, with nitrofurantoin, TMP-SMX, or fosfomycin as first-line options.
E. coli is the most common pathogen.
Choose antibiotics based on local resistance patterns and patient allergies.
Fluoroquinolones are generally reserved for more severe infections.
A mild, stable increase in serum creatinine (up to 30% from baseline) is an expected and acceptable response when initiating an ACE inhibitor or ARB in patients with chronic kidney disease.
ACEIs/ARBs are renoprotective in CKD despite initial GFR drop.
Monitor creatinine and potassium 1-2 weeks after initiation or dose change.
Increase >30% or hyperkalemia warrant dose adjustment or discontinuation.
Non-steroidal anti-inflammatory drugs (NSAIDs) can cause fluid retention and elevate blood pressure by inhibiting prostaglandin synthesis, which affects renal blood flow and sodium excretion.
Common in patients with pre-existing hypertension or heart failure.
Can lead to worsening edema and difficulty controlling blood pressure.
Discontinuation of NSAID is often the first-line intervention.
The quality improvement process involves identifying a problem, analyzing its root causes, developing and implementing solutions, and evaluating their effectiveness.
Root cause analysis is critical for effective interventions.
QI models like PDSA (Plan-Do-Study-Act) guide the process.
Anaphylaxis is a severe, life-threatening systemic hypersensitivity reaction characterized by rapid onset of skin, respiratory, gastrointestinal, and/or cardiovascular symptoms. Immediate intramuscular epinephrine is the first-line treatment.
Rapid onset, involves multiple body systems.
Key symptoms: urticaria, angioedema, wheezing, hypotension, GI distress.
Epinephrine is the only medication that reverses the progression of anaphylaxis.
For partial response to an antidepressant after an adequate trial (typically 4-8 weeks), the initial strategy is usually to increase the dose of the current medication.
Adequate trial duration is crucial before dose adjustment or switching.
Dose escalation is preferred over immediate switching for partial response.
Maximum therapeutic doses should be considered before changing agents.
In patients with Type 2 Diabetes and established atherosclerotic cardiovascular disease (ASCVD), an SGLT2 inhibitor or a GLP-1 receptor agonist with proven cardiovascular benefit should be added to metformin, regardless of A1C.
Prioritize agents with CV benefits in high-risk patients.
SGLT2 inhibitors (e.g., empagliflozin, canagliflozin) reduce MACE and HF hospitalization.
Levetiracetam (Keppra) is an antiepileptic drug with a generally favorable side effect profile, but it is notably associated with significant neuropsychiatric adverse effects, including irritability, aggression, and mood changes.
Common side effects: somnolence, dizziness, fatigue.
After successful treatment of Clostridium difficile infection, high-risk patients (e.g., with multiple recurrences) benefit most from a prolonged, tapered, or pulsed oral vancomycin regimen to prevent further episodes.
Recurrence is common, especially after 3+ episodes.
Oral vancomycin or fidaxomicin are used for treatment and prevention.
Fecal microbiota transplantation (FMT) is another option for refractory recurrent CDI.
For fibromyalgia, if a patient has a partial response to an initial dose of a first-line medication (e.g., duloxetine, pregabalin, milnacipran) and tolerates it well, the dose should be increased to the next therapeutic level.
Duloxetine, pregabalin, and milnacipran are FDA-approved for fibromyalgia.
Titrate medications slowly to minimize side effects.
Aim for maximal tolerated and effective dose before switching or augmenting.
Gestational hypertension (BP ≥140/90 mmHg after 20 weeks gestation without proteinuria) often requires pharmacological management, with labetalol or nifedipine as first-line agents.
Goal BP is typically 120-150/80-105 mmHg.
Regular monitoring for proteinuria and other preeclampsia signs is crucial.
If blood pressure remains above target on the initial dose of a single antihypertensive medication, and the patient tolerates it well, the dose should be increased to the next step before considering adding a second agent.
Titrate to maximum effective dose of first agent.
Most agents have a recommended titration schedule.
Consider combination therapy if monotherapy at maximal dose is insufficient.
When metformin monotherapy fails to achieve glycemic targets, adding a second agent from a different class (e.g., sulfonylurea, DPP-4 inhibitor, SGLT2 inhibitor, GLP-1 receptor agonist) is the next step.
HbA1c target is typically <7% for most adults.
Metformin is first-line pharmacotherapy.
Choice of second agent depends on patient factors, comorbidities, and cost.
For chronic stable angina, if symptoms persist despite beta-blocker therapy, adding a long-acting nitrate is a common next step to improve symptom control.
In chronic heart failure patients experiencing symptoms and signs of fluid overload (e.g., dyspnea, weight gain, edema), the most appropriate initial intervention is to increase the dose of the loop diuretic.
Fluid overload is a common cause of CHF decompensation.
Loop diuretics (e.g., furosemide) are essential for symptom control.
Titrate diuretics based on clinical signs and symptoms of congestion.
If a patient with GAD shows partial improvement on an SSRI after an adequate trial and tolerates the medication, the first step is to increase the SSRI dose to achieve full remission.
SSRI/SNRI are first-line for GAD.
Adequate trial duration is 4-6 weeks at a therapeutic dose.
Titrate to max tolerated dose for full response before switching or augmenting.
Initiating metformin therapy involves starting with a low dose and gradually increasing it to improve tolerability and minimize gastrointestinal side effects.
Common initial dose is 500 mg once or twice daily.
COPD control is assessed by symptom burden, exacerbation frequency, and the need for rescue medication use, with increased SABA use indicating suboptimal control.
SABA use >2 times/week (excluding exercise) suggests inadequate control.
Symptom questionnaires (e.g., CAT, mMRC) help quantify burden.
Frequent exacerbations also indicate poor control.
The 'Study' phase of the PDSA cycle involves analyzing the data collected during the 'Do' phase to understand the results and identify lessons learned.
Comes after 'Do' and before 'Act'.
Involves comparing data to predictions.
Aims to summarize what was learned and identify if the change worked.
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