Empagliflozin, an SGLT2 inhibitor, is the most appropriate choice. For patients with type 2 diabetes and established cardiovascular disease, including HFrEF, SGLT2 inhibitors like empagliflozin are recommended due to their proven cardiovascular and renal benefits, including a reduction in heart failure hospitalizations. The other agents do not provide this specific mortality and morbidity benefit in the context of HFrEF.

For an INR of 3.8 (<5.0) with no significant bleeding, the standard of care is to hold the next 1-2 doses, reduce the weekly dose by 10-15%, and recheck the INR soon. Administering vitamin K is reserved for higher INRs (typically >5.0) or if there is bleeding. Simply holding until therapeutic is less precise, and continuing the same dose is inappropriate as the INR is above goal.

Ulipristal acetate (ella) is effective for up to 120 hours (5 days) after unprotected intercourse and is more effective than levonorgestrel, especially in this timeframe (>72 hours) and for patients with a BMI >25 kg/m² or weight >70 kg (approx. 154 lbs). Levonorgestrel’s efficacy declines after 72 hours and may be less effective in higher-weight individuals. A copper IUD is highly effective but is a procedural intervention. The two-dose levonorgestrel regimen is an older, less common method.

Applying external heat (heating pad, electric blanket, hot bath) over a transdermal fentanyl patch is dangerous. Heat can increase the rate of fentanyl absorption, potentially leading to a fatal overdose. The other statements are correct: application to clean, dry, non-hairy skin; site rotation to avoid skin irritation; and proper disposal by folding to prevent accidental exposure.

Oral corticosteroids like prednisone are the safest first-line option for acute gout in patients with significant renal impairment (eGFR <30). NSAIDs like indomethacin are contraindicated due to the risk of worsening renal function and GI toxicity. The high-dose colchicine regimen poses a high risk of toxicity (neuromuscular, myelosuppression) in renal failure. While low-dose colchicine (0.6 mg daily or every other day) can be used with extreme caution, initiating therapy with a steroid burst is the standard safer choice for an acute flare in this population.

For a non-severe, delayed-onset penicillin allergy (like isolated hives), cephalosporins like cefdinir are often used cautiously. However, for a reported immediate-type hypersensitivity reaction involving hives AND angioedema (swelling of lips), the risk of cross-reactivity with cephalosporins is higher, and they should be avoided. Azithromycin is a macrolide with no cross-reactivity with penicillins and is a recommended alternative for otitis media in penicillin-allergic patients. Amoxicillin-clavulanate is contraindicated. Clindamycin does not have reliable coverage against the common otitis media pathogens (H. influenzae, M. catarrhalis).

Oxybutynin is a strong anticholinergic medication. The American Geriatrics Society Beers Criteria strongly recommends avoiding oxybutynin (especially immediate-release) in older adults due to its high anticholinergic activity, which is associated with increased risk of confusion, dry mouth, constipation, urinary retention, and accelerated cognitive decline. The other medications (furosemide, metoprolol, warfarin) are not primarily anticholinergic, though they have other potential risks in the elderly that require monitoring.

According to the Clozapine REMS, an ANC result between 500 and 999 cells/mm³ (for the general population) falls under “Benign Ethnic Neutropenia (BEN) Range” or “Mild Neutropenia” depending on baseline. However, an ANC of 900, if not consistent with the patient’s baseline BEN status, typically triggers a “Green Zone” action for non-BEN patients: interrupt therapy and repeat ANC within 24 hours. Continuation is not permitted without confirmatory testing. Permanent discontinuation is for ANC <500 (or upon confirmation of a significant drop). Dose adjustment is not a standard or appropriate initial response to a low ANC.

Dextromethorphan is a serotonin reuptake inhibitor. When combined with fluoxetine, a potent SSRI, there is a significant risk of additive serotonergic effects, potentially leading to serotonin syndrome. The other agents do not have primary serotonergic activity: calcium carbonate is an antacid, loratadine is a non-sedating antihistamine, and famotidine is an H2-receptor antagonist.

Empagliflozin, an SGLT2 inhibitor, is the most appropriate choice. For patients with type 2 diabetes and established cardiovascular disease, including HFrEF, SGLT2 inhibitors like empagliflozin are recommended due to their proven cardiovascular and renal benefits, including a reduction in heart failure hospitalizations. The other agents do not provide this specific mortality and morbidity benefit in the context of HFrEF.0