Exam 3 Video Quiz Q & A and M12 CS

Question 1

Goal INR is between 2.0 and 3.0.

Answer 1

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Question 2

Fish oils increase the risk of bleeding additively with warfarin.

Answer 2

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Question 3

With an INR of 3.2 it’s close to range, so just hold that dose of warfarin, continue with current 5 mg of warfarin, and re-check INR in one week. If it’s high again next week, reduce his TWD by 5-10% which would be 1.75 to 3.75.

Answer 3

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Question 4

If patient’s INR came back >10/unreadable, what would you order for him?

• Hold warfarin and administer vitamin K

Answer 4

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Question 5

If the patient has ASCVD and/or a a LDLc >190 mg/dL, target LDL reduction is >50%, and use a high intensity statin.

Also if their ASCVD risk is > 7.5%.

Answer 5

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Question 6

Pt to receive a high intensity statin if ASCVD risk is > 7.5%.

Answer 6

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Question 7

If there’s no LDL baseline on a patient, get their LDL down below 70.

Answer 7

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Question 8

HDL > 40 is desirable.

Answer 8

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Question 9

TG < 150 is desirable.

Answer 9

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Question 10

Once your TGs get up to over 500, you run the risk of developing pancreatitis.

Answer 10

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Question 11

Asthma: LAMA only.

For COPD, can use both SAMA and LAMA.

Answer 11

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Question 12

If you have a COPD patient in the hospital for a COPD exacerbation, you would put them on oral or injectible corticosteroids, and a LAMA combined with a LABA.

Once stable, and no sx of an exacerbation, and had a hx of asthma or eosinophils >300, or in a super-sever stage, then we would add it back (ICS).

Answer 12

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Question 13

ICS are only for stable COPD patients (those pts not experiencing an exacerbation).

Answer 13

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Question 14

GOLD 2020 GUIDELINES:

• Factors to assess when considering ICS:

Strong support:
- Hospitalization for COPD exacerbation
- ≥ 2 moderate COPD exacerbations/year
- Eosinophils >300
- History/concomitant asthma

Answer 14

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Question 15

Are IL-5 antibodies considered a last resort for asthma treatment?

Yes or No?

Answer 15

Yes.

Question 16

Do all pts with SIHD receive the ASA + ACEI + Statin combo (unless allergic or CI)?

Answer:

Figure 7.5 is correct. But it also goes on to say if LV dysfunction, CKD, or MI they also get an ACEI/ARB. Remember the ABCDEs of IHD. Honestly though, 99% of people with IHD already have one of those comorbidities, the other 1% are variant angina, so that is why they say all patients with IHD need the combo.

Answer 16

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Question 17

In the objectives for HTN it is asked: “What are 2 drugs other than potyassium supplements that reduce potassium loss during diuresis?”

Directly the K-sparing diuretics amiloride and triamterene would count. Also spironolactone and the ACEI/ARB can cause hyperkalemia so they can definitely reduce potassium loss during diuresis too.

Answer 17

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Question 18

Cardioselective BBs: Are they OK to give to someone with asthma vs nonselective BB?

Answer: Yes, they are OK. I would just alert the patient that if they experience worsening asthma symptoms we would need to change their BB or choose a different medication. You can further break up the cardioselective BBs into ISA and non-ISA activity to be even more patient selective. Even though that does not matter for this exam.

Answer 18

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Question 19

Why is LTRA considered steroid-sparing?

It has everything to do with inflammation. By inhibiting certain leukotrienes this decreases inflammation in the lungs which decreases the need for topical anti-inflammatories like inhaled steroids.

Answer 19

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Question 20

Should we know the 1st gen antihistamines vs 2nd gen?

I would know which are which because 1st gen are for allergy exacerbation, and are not recommended for allergy prophylaxis due to severe side effects, while 2nd gen are the opposite.

Answer 20

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Question 21

Anything that ends in “-amine” is a 1st-gen antihistamine.

“-zines” and “-dines” are second generation.

Answer 21

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Question 22

For asthma, you would never use anything but a combo-inhaler (ICS/formoterol).

You would never give a LABA by itself for asthma.

Answer 22

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Question 23

LABAs can be given by themselves in COPD, but NOT in asthma.

LABAs: ending in “-terol.”

Formoterol, salmeterol, arfomoterol

Answer 23

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Question 24

EPR3 has step 6, and GINA only goes up to step 5.

Answer 24

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Question 25

Know that pneumococcal vaccines are recommended for all asthma and COPD patients.

Answer 25

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Question 26

A thiazide diuretic would be first-line treatment for HF.

Loop diuretics come later in C/III or C/IV.

A PRN loop diuretic for edema is good for any stage of HF.

Answer 26

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Question 27

In renal insufficiency, higher diuretic doses are required to overcome disease-related impediments to drug delivery to their sites of action. In the case of the loop diuretics the common practice is to titrate the dose of the diuretic until the desired response occurs.

For exammple if you were to give 20 mp of Lasix for a patient with a CrCl of 80, and now their CrCl is, say, 35, you would have to perhaps give 80 mg or more of the Lasix until the desired response occurs.

Answer 27

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Question 28

BBs can mask the symptoms of hypoglycemia.

Answer 28

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Question 29

Know the general starting dose for warfarin, the reversal agent, and general dosing (like changes to the dose based on INR).

Answer 29

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Question 30

Could you elaborate on theophylline and its current place in therapy for asthma and COPD as well as how it has fallen out of favor?

• It can be used in the algorithm for either (asthma or COPD) where long-acting bronchodilators are IF a pt cannot tolerate a LABA or LAMA or are on 3 or 4 med therapy and still symptomatic. It also has better outcomes if the pt has allergic asthma unresponsive to other combos: it’s the last step before immunotherapy.
• Theophylline has fallen out of favor because of the NTI and the number of side effects/precautions associated with it. For example it is not OK to give in any cardiac disease even if pt has COPD or asthma.
• “Oral theophylline has been used as a bronchodilator to treat COPD for decades, but it has fallen out of favor due to the SEs that come with the higher doses that are required to achieve any beneficial effort.”

Answer 30

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