Cardio and Peripheral Vascular

Question 1

JNC 8: BP by Age

Start pharmacotherapy if BP exceeds:

Answer 1

140/90 mm Hg
<60 years old
CKD

150/90 mm Hg
≥60 years DM

Question 2

Choice of Antihypertensive Agents
• JNC 8
 Black patient:
 Non-Black patient:

Answer 2

 Black patient: Thiazide diuretic, CCB
 Non-Black patient: Thiazide diuretic, CCB, ACE, ARB

Question 3

Choice of Antihypertensive Agents
ACC/AHA

Answer 3

 Thiazide diuretic, ACE, ARB, CCB

Question 4

Amlodipine

Answer 4

CCB- can also worsen lower extremity edema

Question 5

preventing calcium from entering the cells of the heart and arteries. Calcium causes the heart and arteries to squeeze (contract) more strongly. By blocking calcium, calcium channel blockers allow blood vessels to relax and open.

Answer 5

CCB- Almodipine, Nifedipine

Question 6

Not an initial choice from JNC8 or ACC/AHA for HTN mgmt

Answer 6

Beta Blocker- (ex. Metoprolol )

Question 7

also known as beta-adrenergic blocking agents, are medications that reduce blood pressure. work by blocking the effects of the hormone epinephrine, also known as adrenaline= cause the heart to beat more slowly and with less force, which lowers blood pressure.

Answer 7

Beta blockers (Metoprolol)

Question 8

angiotensin II receptor blocker

Answer 8

Losartan

Question 9

work by blocking receptors that the hormone acts on, specifically AT1 receptors, which are found in the heart, blood vessels and kidneys. Blocking the action of angiotensin II helps to lower blood pressure and prevent damage to the heart and kidneys

Answer 9

ARBs <angiotensin>
(ex. Losartan) </angiotensin>

Question 10

Prevent the conversion of angiotensin I to angiotensin II, which disrupts the renin-angiotensin-aldosterone system (RAAS). Failure to convert angiotensin I to angiotensin II results in relative vasodilation…
increase plasma renin activity = smooth gradual BP reduction without affecting HR or cardio reflexes

Answer 10

Angiotensin Converting Enzyme Inhibitors (ACEI) (-Pril)

Lisinopril, Enalapril

Question 11

Decrease sodium reabsorption and therefore decreased fluid reabsorption; this directly causes decreased levels of circulating sodium= decreased Afterload and BP

Answer 11

Thiazide Diuretics (Chlorthalidone, Hydrochlorothiazide)

• not good if pt has sulfa allergy

Question 12

What should be checked in 2 weeks if amlodipine is prescribed?

Answer 12

Amlodipine is a CCB and does not need labs to rx

Question 13

What should be checked in 2 weeks if lisinopril is prescribed?

Answer 13

Ace inhibitors cause body to hold onto K+
*Check K+ and Renal Studies (BUN, Cr)

Question 14

What labs should be ordered if losartan is been prescribed?

Answer 14

hypotension, renal function, and potassium levels.

Question 15

What should be checked in 2 weeks if chlorthalidone is prescribed?

Answer 15

Potassium

(thiazide diuretics dump K+ so need to watch for hypokalemia)

Question 16

You prescribed 20 mg lisinopril daily for Mr. Thibodeaux. He returns in 4 weeks. Which choices are reasonable?

30 days ago 138/90 12 days ago 140/95 21 days ago 138/85 2 days ago 138/90 14 days ago 130/90 Yesterday 135/85

1. Continue plan for another 4 weeks.
2. Increase lisinopril to 40 mg daily.
3. Add 50 mg losartan.
4. Add 5 mg amlodipine.
5. Add 12.5 mg chlorthalidone.

Answer 16

2. Increase lisinopril to 40 mg daily.
3. Add 5 mg amlodipine.
4. Add 12.5 mg chlorthalidone.
5. Add 50 mg losartan. (NEVER COMBINE ACE AND ARB- both work in RAS system)

Question 17

Total cholesterol= 210 mg/dL
HDL= 38 mg/dL
LDL 130 mg/dL
Triglycerides= 323 mg/dL A1C 6.5%

ASCVD risk of 10.8 do they need statin?

Answer 17

Yes, need to decrease risk of heart event

Question 18

History of CHD or stroke… Recommended LDL Reduction with Statin

Answer 18

50% reduction: atorvastatin 40, 80 mg or rosuvastatin 20, 40 mg

Question 19

LDL >190 mg/dL (familial hyperlipidemia)
Recommended LDL Reduction with Statin

Answer 19

50% reduction

Question 20

DM, aged 40-75, LDL 70-189 mg/dL
Recommended LDL Reduction with Statin

Answer 20

30-49% reduction: Atorvastatin 10, 20 mg,
Rosuvastatin 5, 10 mg, simvastatin 10, 20 mg, pravastatin 20, 40 mg

Question 21

Recommended LDL Reduction with Statin

Global 10-year risk score ≥7.5% (primary prevention)

Answer 21

30-49% reduction

Question 22

You’ve decided to prescribe 10 mg of rosuvastatin for Mr. Thibodeaux. This is:

1. precarious if LFTs have not been ordered recently.
2. an example of primary prevention.
3. aggressive considering his risk factors.
4. going to reduce his risk of a cardiovascular event by 30-49%.

Answer 22

2. an example of primary prevention.

Question 23

When do you want to initiate a fibrate?

Answer 23

When triglycerides are above 500
(goal < 150)

Question 24

Type of med that causes body to hold onto sodium ( increase in h20 retention) increases BP along with lower extremity edema

Answer 24

Naproxen (NSAID)
Dont want a patient with high BP taking

Question 25

How do you want to address his mild lower extremity edema (present for about 6 weeks)? 1. Ask about SOB, chest pain, cough 2. Add furosemide 3. Stop amlodipine 4. Stop naproxen 5. Order a TSH 6. Order a BNP 7. Order a chest X-ray.

Answer 25

1. Ask about SOB, chest pain, cough (rule out heart failure) 4. Stop naproxen (lower extremity edema) Do not put on amlodipine (a CCB) - can increase lower extremity edema Dont want furosemide yet because dont know exact cause

Question 26

A repeat potassium level for Mrs. Boudreaux demonstrates 5.6 mmol/L. She is asymptomatic. How should this be handled today? 1. Refer to nephrology 2. Refer to ER 3. Add a medication 4. Discontinue a medication

Answer 26

4. Discontinue a medication- Triamterene/HCTZ