Goals, Safety, And Effectiveness Practice Test

A 40-year-old woman (62 kg, 168 cm) presents with nausea, tremor, and confusion 5 days after her psychiatrist increased lithium carbonate from 300 mg twice daily to 600 mg twice daily. Current medications: lithium carbonate 600 mg twice daily, ibuprofen 600 mg three times daily for back pain (started 1 week ago), sertraline 100 mg daily. PMH: bipolar disorder. Labs: lithium level 1.9 mEq/L (high; typical maintenance 0.6–1.2), SCr 1.3 mg/dL (baseline 0.8). Allergies: none. Which drug-related problem needs immediate attention?

An 81-year-old woman (54 kg, 155 cm) living independently presents for a comprehensive medication review due to dizziness and two recent falls. Current medications: diphenhydramine 25 mg nightly for sleep, diazepam 5 mg three times daily as needed for anxiety (uses daily), oxybutynin IR 5 mg three times daily, lisinopril 10 mg daily, acetaminophen 650 mg three times daily as needed. PMH: HTN, overactive bladder, insomnia, generalized anxiety. Labs: SCr 0.9 mg/dL. Allergies: none. How should the patient's medication regimen be adjusted?