Cardiac/renal

Question 1

Thiazide diuretics

Answer 1

HCTZ
*high dose therapy with HCTZ should be avoided due to increase risk of hypokalemia. Instead use combination of spironolactone + HCTZ

Question 2

Loop diuretics

Answer 2

Furosemide, torsemide

Question 3

Use caution with ________ if allergy to Bactrim (sulfa)

Answer 3

Loop diuretics (furosemide, torsemide)

Question 4

Watch for hyperlipidemia in pt’s taking:

Answer 4

thiazide diuretics (HCTZ)

Question 5

Potassium sparing diuretics

Answer 5

Spironolactone
often used in combination with HCTZ

Question 6

Heart failure treatment

Answer 6

Stage a: ACEI!
Stage b: ACEI + BB

Question 7

Cardiac glycosides

Answer 7

Digoxin

Question 8

Digoxin ADR

Answer 8

toxicity in levels over 1mg/ml.
Increased risk of mortality in women

Question 9

Antiarrhythmics

Answer 9

1. Sodium channel blockers (flecainide, lidocaine),
2. Beta blockers
3. Potassium channel blocker (amiodarone)
4. Calcium channel blockers(verapamil, cardizem)

Question 10

Antiarrhthmic education

Answer 10

Educate patient on labs to monitor potassium, BUN/Cr, therapeutic drug levels. Baseline EKG.

DO NOT double dose.
Be aware of food-drug interactions.

Question 11

HTN guidelines

Answer 11

1. ACEI/ARB: first line for caucasians
2. CCB: first line for African americans

Add thiazide diuretic if ineffective to control ^

Question 12

When to initiate hypertensive therapy

Answer 12

If SBP greater than 20mmHg above goal.

Question 13

Prescribe ACEI to which pts:

Answer 13

1. White caucasians with primary HTN.
2. DM pts for nephopathy
3. Cardiac pts to reduce remodeling. tx angina after MI.

Question 14

ACEI ADR

Answer 14

4x greater risk of angioedema in African Americans/asians

Hypotension, dry cough, loss of taste, blood dycrasias

Question 15

CKD use:

Answer 15

ACEI until stage 3

Question 16

Stroke prevention

Answer 16

Use ACEI + diuretic + ASA

Question 17

What HTN med to use in pregnancy

Answer 17

NOT ACEI/ARB. Avoid.
Use BB.

Question 18

Avoid BB in pt’s with

Answer 18

Severe or uncontrolled asthma

Question 19

Do not take amiodarone with:

Answer 19

Grapefruit juice!

Question 20

Dyslipidemia meds

Answer 20

1. Statins (may cause rhabodo)
2. Fibrates: Work for pts with VERY high TG levels (but not substantial decrease in LDL)
   *monitor lipid levels!
3. Bile acid sequestrants:
   Only class to use with liver failure. ADR related to intestine metabolism. Gas, constipation, bloating. Mix one packet with juice, never swallow dry.
4. Niacin: No longer approved by FDA for lipid management
5. Zetia: Best used if combined with other dyslipidemic

Question 21

Bile acid sequestriants are the only class of dyslipidemic used for:

Answer 21

1. liver disease
2. PREGNANCY.

Question 22

Do not prescribe statins to pt’s with

Answer 22

PREGNANCY!

Question 23

When to treat LDL

Answer 23

Do not necessarily have to treat if just high LDL. Treat if other risk factors for CV events.
Children/adolescents goal cholesterol is under 170.
Use primary prevention measures first: Diet/exercise.
Use ASCVD risk calculator to determine if statin necessary

Question 24

Should you do regular liver lab levels with statins

Answer 24

No, not significant enough to do regular monitoring. Passive monitoring of symptoms is better approach.