A Medical Intern Is Working on the Inpatient Wards at a Busy

A medical intern is working on the inpatient wards at a busy community hospital.  During rounds, the team evaluates a new patient admitted for worsening congestive heart failure.  The patient's past medical history includes atherosclerotic coronary artery disease, diabetes mellitus, and pulmonary hypertension.  Current medications include metformin, aspirin, and enalapril.  On previous admissions, the patient admitted to using cocaine recreationally with friends and admits to the intern that his last use was today.  The attending physician asks the intern to start the patient on propranolol for his heart condition; he will be expected to continue this medication following hospital discharge.  After rounds, the intern recalls that during medical school she learned that beta adrenergic antagonists can interact poorly with cocaine.  Which of the following actions by the intern is most appropriate?

A) Administer the drug as the attending physician has likely considered the risks and benefits of a beta blocker in combination with cocaine
B) Discuss concerns with the nurses, ask for their input, and have them monitor the patient's vital signs when starting the medication
C) Discuss the risks and benefits of the medication with the patient and let him decide whether to take it
D) Do not order the medication as the most important principle in medicine is to "do no harm"
E) Do not order the medication until discussing concerns with the attending physician and asking how to proceed

Correct Answer:

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