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 cant 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. Lab results: Hb: 11 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
Posted on: Mon, 15 Dec 2014 19:24:36 +0000
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