Errors, Omissions, And Duplication Practice Test

A 52-year-old man (weight 95 kg) with chronic low back pain requests an early refill and reports taking extra doses for breakthrough pain. Medical history includes chronic pain and depression. Current medications: oxycodone immediate-release 5 mg by mouth every 6 hours as needed, oxycodone extended-release 10 mg by mouth every 12 hours, sertraline 100 mg by mouth daily, and docusate 100 mg by mouth twice daily. Pertinent labs: serum creatinine 0.9 mg/dL (0.6–1.3), alanine aminotransferase 24 units/L (7–56). Allergies: none. What is the most significant error in this patient's medication regimen?

A 60-year-old male (weight 83 kg) is started on spironolactone for heart failure. Medical history includes HFrEF and hypertension; allergies: none. Current medications: spironolactone 25 mg by mouth daily (new), lisinopril 20 mg by mouth daily, carvedilol 12.5 mg by mouth twice daily, furosemide 20 mg by mouth daily. Baseline labs today: potassium 4.9 mEq/L, serum creatinine 1.3 mg/dL. What monitoring is needed for this patient?