u*****o
发帖数: 125 | 1 A 95-year-old woman is admitted to the hospital because she fractured her right femur when she fell at home. An operation is planned and you are consulted by the orthopaedic surgeon for medical clearance. She is a widow with no children who lives alone at home. She has diabetes mellitus that is treated with glyburide. She also takes aspirin, daily, and flurazepam for insomnia. On the night of admission she was noted to be confused and disoriented. She became somewhat agitated and tried
to get out of bed. She repeatedly yelled, "You can't keep me in prison
against my will."
Today, at the time of the consultation, she is alert and oriented to time, place, and person. She does not remember the events
of last evening. Vital signs now are temperature 36.7°C (98.0°F), pulse 78/min and regular, respirations 14/min, and blood pressure 138/84 mm Hg. On physical examination, heart, lungs, and abdomen
are normal. The left leg is shortened and externally rotated. There are strong peripheral pulses bilaterally. Test of the stool for occult blood is positive. Results of laboratory studies are shown:
Serum Blood
Glucose 183 mg/dL Hemoglobin 11.4 g/dL
Electrolytes Normal Hemoglobin A1c 8.6%
WBC 7000/mm3
The patient says she has a moderate amount of pain in the hip despite receiving acetaminophen. Which of the following is the most appropriate pharmacotherapy:
A. Amitriptyline, orally
B. Fentanyl patch
C. Hydrocodone, orally
D. Meperidine, orally
E. Sustained-release morphine, orally | g**********8
发帖数: 86 | 2 我想我会选择C。因为E和B起效慢。E估计要几小时，B要12小时左右。 | u*****o
发帖数: 125 | |
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