A patient with rheumatoid arthritis is taking leflunomide [Arava] and an oral contraceptive. She tells the nurse she would like to get pregnant. What will the nurse tell her?
a. That leflunomide is not dangerous during the first trimester of pregnancy
b. That plasma levels of leflunomide will drop rapidly when she stops taking it
c. To ask her provider about an 11-day course of cholestyramine
d. To stop taking leflunomide when she stops using contraception
C
Leflunomide is contraindicated during pregnancy. Patients desiring pregnancy must follow a three-step protocol that includes stopping the drug, taking cholestyramine to chelate the lefluno-mide, and ensuring that leflunomide drug levels are below 20 mcg/L before getting pregnant. Leflunomide is teratogenic and is not safe during pregnancy. Plasma levels of leflunomide may take 2 years to drop without using cholestyramine. It is not correct to stop taking leflunomide without following the protocol.
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The parents of a 9-year-old are concerned about their child sleeping 11 hours at night. The nurse explains that age-related sleep habits include: Standard Text: Select all that apply
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