"Case" Questions over everything

Question 1

Your patient comes to PT complaining of being very thirsty and “having a dry mouth” during your session. What HTN medicine is causing this?

Answer 1

Clonidine=3rd Order HTN med (Central Alpha 2 Agonist)

-Adverse effect is dry mouth. Other side effects include fatigue, dizziness, hypotension, bradycardia, rebound hypertension (do not stop abruptly)

Question 2

You notice your patient is taking Hydralazine. What other medications must he be on in order to take this?

Answer 2

Needs to be on a Beta Blocker and a diuretic. Hydralazine is a fourth line HTN medication, very strong direct vasodilator.

Question 3

You notice your client has swelling in his legs compared to last session and at the start of exercise seems flushed. What new drug that he is one to manage his HTN would be causing this?

Answer 3

Amlodipine = Ca Channel Blocker

Adverse effects: Peripheral edema, constipation, flushing

Question 4

Your patient has CHF he has a low CO and his ventricles are hypertrophied and the myocardium is thin. What medication would you suspect he is on?

Answer 4

Digoxin–Treats systolic CHF

*Inhibits Na/K pump in myocardial cells resulting in increase of intracellular Na, which promotes Ca influx via Na/Ca exchange pump leading to increased contractility.

Question 5

You notice your patient is taking a Ca Channel Blocker and Digoxin…what is the problem?

Answer 5

Ca Channel Blockers–Blocks Ca channels in heart/ aterial smooth mm; reducing cardiac contractility

Digoxin increases Ca influx via the Na/Ca exchange pump leading to increased contractility

Question 6

A patient has a heart rate of 130. What drug is hard to prescribe because the side effects can be life threatening.

Answer 6

Amiodarone–This is an antiarrhythmic drug whose side effects include multiple drug-drug interactions: liver toxicity; fatal arrhythmias, pulmonary toxicity; corenal toxicity; very long half life

Other antiarrhytmic durgs: Lidocaine, beta blockers, Ca channel blockers, digitals can be used

Question 7

Your patient has been on HTN meds for 15 years. What would you expect him to be taking for his current medications?

Answer 7

• Hydrocholorthiazide (weak first order diuretic)
• Lisionpril (ACE)
• Metoprolol (B-Blocker) or Amlodipine (Ca Blocker)
• Clonidine=3rd Order HTN med (Central Alpha 2 Agonist)
• Hydralazine=Direct Vasodilator (4th line therapy)

Question 8

Pt has hyperaldostonism. What medication is he likely on?

Answer 8

K Sparing Drug such as spironolactone

Question 9

<p>
Pt has become very fatigue with his exercise and complains of being tired. He currently added a new HTN medication...what is the most likely drug?</p>

Answer 9

<p>

| Beta Blocker--Metoprolol...Adverse side effects are fatigue, decreased exercise tolerance and bradycardia</p>

Question 10

Why should a person who has asthma not take a beta blocker?

Answer 10

An adverse side effect for beta blocker is bronchospasms.

Question 11

A pt is having CHF where his vents aren’t able to relax enough for proper filling. His myocardium is thickened and stiff around his ventricles. What medication do you suspect he is on?

Answer 11

Beta Blocker–Helps w/diastolic CHF….need to be aware of side affects for PT=fatigue, dec ex tol, bradycardia

Question 12

Pt has an enlarged prostate and and HTN? What med is he likely on?

Answer 12

Alpha 1 Blocker–“azosin” PT needs to be aware of orthostatic hypotension (first dosage especially), dizziness, fatigue

Question 13

Pt has CHF what drugs do you expect to see?

Answer 13

• Furosemide (Loop Diuretic)
• Lisinopril (ACE) or “SARTAN” (ARB)
• Depending on if systolic (digoxin) or diastolic (beta blocker)

Question 14

Pt has coronary artery disease, what is their medicine line up?

Answer 14

• Aspirin
• Beta Blocker (olol)
• ACE (pril) or ARB (SARTAN)
• Nitrate

Question 15

Your patient is on a B2 Agonist Inhaler for asthma. What are some things you need to pay attention to in your session?

Answer 15

Adverse side effects of hypertension, tachycardia, anxiety and palpitations—all sympathomimetic effects!

B2 Agonist=Anything w/ “terol”, ex: Albuterol (rescue inhaler), causes bronchodilataion

Question 16

Your patient is taking Fluticasone, why?

Answer 16

Asthma- This is a inhaled corticosteriod “asone” for the use of asthma/COPD. Potential adverse effects are upper resp tract infection.

Question 17

Your patient is on flexeril, what adverse effect should you be most concerned about?

Answer 17

Flexeril is an antispasm drug. The major adverse side effect is sedation=safety risk!

Other side effects include confusion, headache, N/V

Question 18

Why should a person who has pulmonary dysfunction or myocardial disease not take dantolene (dantrium)

Answer 18

Dantrium is a anti-spasmolytic that interferes with excitation-contraction coupling.,,,this interferes with Ca flux thus affecting SR activity

Question 19

These type of drugs are commonly used for deliberate overdose/suicide attempts.

Answer 19

• Bensodiazepines.
• Induce severe respiratory and cardiovascular depression, these potentially lethal effects are enhanced by the inclusion of alcohol, barbiturates or antideprssants

Question 20

You have a patient who c/o only of pain. What type of analgesic should she take?

Answer 20

Acetaminophen (tylenol, datril, excedrin) since this is effective for pain relief. You wouldn’t use an NSAID since it has a anti-inflammatory effect that you do not need.

Question 21

Your patient has had recent back surgery and is in PT. She has a severe symptoms of respiratory distress due fetanyl….what medication should she take?

Answer 21

Fetanyl is a strong opioid. Take naloxone since it is it’s antagonist.

Question 22

Your patient is taking a drug for the first time and you notice signs of orthostatic hypotension. What type of drug might he be one?

Answer 22

Alpha 1 blocker “azosin” such as doxazosin

• Adverse effects cause orthostatic hypotension w/first dose, also see dizziness, fatigue, urinary incontinence.
• Used to tx HTN, urinary outflow obstruction, BPH

Question 23

Your patient is on a very potent vasodilator used for the tx of CAD…this is a big contraindication for therapy. What drug would you suspect he is on?

Answer 23

Niroglycerin (Nitrate)–Long acting nitrates are a big contraindication for PT.