A 63-year-old male with chronic GERD has been taking omepraz…

A 63-year-old male with chronic GERD has been taking omeprazole daily for 3 years. He presents with fatigue and numbness in his feet. Laboratory results reveal macrocytic anemia and low serum vitamin B12 levels. Which of the following best explains the mechanism underlying this adverse effect?  

A 71-year-old female with severe COPD (FEV₁ 38% predicted) p…

A 71-year-old female with severe COPD (FEV₁ 38% predicted) presents for follow-up. She has chronic bronchitis symptoms and reports two hospitalizations for COPD exacerbations in the past year despite adherence to triple inhaler therapy (fluticasone/umeclidinium/vilanterol). She quit smoking 3 years ago. FEV 1= 42%. Blood eosinophil count is 90 cells/µL. She denies asthma history. Oxygen saturation is 93% on room air. BMI is 21 kg/m². Which of the following is the most appropriate next step in pharmacologic management?