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pharm 2 Flashcards

11, 12, 37, 13, 42, 38, 41

1
Q

Charlie is a 65 year-old male who has been diagnosed with HTN and BPH. Doxazosin has been chosen to treat his HTN because it:

A

relaxes smooth muscle in the bladder neck

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2
Q

To reduce potential adverse effects, patients taking a peripherally acting alpha 1 antagonist should do all of the following EXCEPT:

A

monitor their blood pressure and skip a dose if their pressure is less than 120/80

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3
Q

John has clonidine, a centrally acting adrenergic blocker, prescribed for his HTN. He should:

A

Not miss a dose or stop taking the drug because of potential rebound HTN.

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4
Q

Clonidine has several off-label uses including:

A

both 1 & 2
1.alcohol and nicotine with-drawl
2.post-herpetic neuralgia

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5
Q

Jim is being treated for HTN. Because he has history of heart attack, the drug chosen is atenolol. Beta-blockers treat HTN by:

A

reducing vascular smooth muscle tone

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6
Q

which of the following adverse effects are less likely in a beta 1 - selective blocker

A

impaired insulin release

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7
Q

Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual lab work and find CrCl of 25 ml/min, What action should you take?

A

extend the dosage interval

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8
Q

Beta blockers are the drugs of choice for exertional angina because they:

A

decrease myocardial oxygen demand by decreasing heart rate and vascular resistance

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9
Q

adherence to beta blocker therapy may be affected by their:

A

effects on the male genitalia, which may produce impotence

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10
Q

beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the:

A

left ventricular function is diagnosed

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11
Q

abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk of for serious consequences of rapid withdrawal are those with:

A

both 1 and 2
1. angina
2. coronary artery disease

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12
Q

to prevent life threatening from rapid withdrawal of a beta blocker:

A

the dosage should be decreased by 1/2 every 4 days

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13
Q

beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia and block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose?

A

diaphoresis

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14
Q

combined alpha-beta antagonists are used to reduce the progression of heart failure because they:

A

vasodilate the peripheral vasculature

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15
Q

carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes:

A

all the above:
histamine 2 blockers
quinolones
serotonin re-uptake inhibitors

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16
Q

alpha-beta blockers are especially effective to treat HTN for which ethnic group:

A

african-american

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17
Q

bethanechol:

A

increases detrusor muscle tone to empty the bladder

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18
Q

clinical dosing of bethanechol:

A

starts at 5mg to 10mg PO and is repeated every hour until a satisfactory clinical response is achieved

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19
Q

patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects:

A

diphenhydramine

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20
Q

anticholinesterase inhibitors are used to treat:

A

myasthenia gravis

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21
Q

which of the following drugs used to treat Alzheimers disease is not an anticholinergic:

A

memantine

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22
Q

taking which drug with food maximizes its bioavailability:

A

Rivastigmine

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23
Q

which of the following drugs should be used only when clearly needed in pregnant and breastfeeding women:

A

Pyridostigmine

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24
Q

There is a narrow margin between first appearance of adverse reaction to AChE inhibitors and serious toxic effects. Adverse reactions that require immediate action include:

A

Fasciculations of voluntary muscles

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25
Q

Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily:

A

Donepezil

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26
Q

Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine:

A

vasodilation and decreased heart rate

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27
Q

nicotine gum products are:

A

bound to exchange resins so the nicotine is only release during chewing

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28
Q

Nicotine replacement therapy (NRT):

A

delays healing of esophagitis and peptic ulcers

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29
Q

success rates for smoking cessation using NRT:

A

vary from 40% to 50% at 12 months

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30
Q

Cholinergic blockers are used to:

A

all the above
counteract EPS effects of phenothiazines
control tremors/relax smooth muscle in Parkinson’s Disease
inhibit the muscarinic action of ACh on bladder muscle

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31
Q

several classes of drugs have interactions with cholinergic blockers. Which of the following is true of these interactions:

A

drugs with a narrow therapeutic range given orally may not stay in the GI tract

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32
Q

Scopolamine can be use to prevent N/V associated with motion sickness. The patient is taught to:

A

swallow the tablet 1 hour before traveling where motion sickness is possible

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33
Q

You are managing the care of a patient recently diagnosed with BPH. He is taking tamsulosin but reports dizziness when standing abruptly. The best option for this patient is:

A

discontinue the tamsulosin and start doxazosin

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34
Q

you are treating a patient with a diagnosis of Alzheimer’s disease. The patient’s wife mentions difficulty with transportation to the clinic. Which medication is the best choice:

A

Donepezil

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35
Q

a patient presents with a c/o of dark stool and epigastric pain described as gnawing and burning. Which of the meds is the most likely cause:

A

Bethanechol

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36
Q

your patient calls for an appointment before going on vacation. Which medication should you ensure he has an adequate supply of before leaving to avoid life threatening complications.

A

carvedilol

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37
Q

activation of central alpha 2 receptors results in inhibition of cardioacceleration and _____ centers in the brain

A

vasoconstriction

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38
Q

Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include:

A

Anorexiants may cause tolerance and should only be prescribed for 6 months

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39
Q

Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St John’s wort due to:

A

The risk of serotonin syndrome

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40
Q

Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine
antiseizure medication, she should also have a home prescription for _____ to be used for an episode of status epilepticus.

A

Rectal diazepam (Diastat)

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41
Q

Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:

A

For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment

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42
Q

Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include:

A

Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance.

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43
Q

Carbamazepine has a Black Box Warning due to life-threatening:

A

Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis

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44
Q

Long-term monitoring of patients who are taking carbamazepine includes:

A

complete blood count every 3-4 months

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45
Q

Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for:

A

Blood dyscrasias, which are uncommon but possible

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46
Q

Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action would be:

A

Assess for suicidal ideation

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47
Q

Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be:

A

Reassure her that this is a normal side effect of topiramate and continue to monitor her weight

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48
Q

Monitoring of a patient on gabapentin to treat seizures includes:

A

Recording seizure frequency, duration, and severity

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49
Q

Scott’s seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes:

A

He should monitor his temperature and ability to sweat in the heat while playing

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50
Q

Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her:

A

To not abruptly discontinue levetiracetam due to risk for withdrawal seizures

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51
Q

Levetiracetam has known drug interactions with:

A

Few, if any, drugs

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52
Q

Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:

A

Ruling out a hypersensitivity reaction that may lead to multi-organ failure

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53
Q

Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause:

A

Reduced lamotrigine levels, requiring doubling the dose of lamotrigine

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54
Q

The tricyclic antidepressants should be prescribed cautiously in patients with:

A

Heart disease

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55
Q

A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs):

A

All of the above

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56
Q

Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for children is:

A

Fluoxetine

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57
Q

Suzanne is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression. Education regarding her antidepressant includes:

A

SSRIs may take 2 to 6 weeks before she will have maximum drug effects.

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58
Q

Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be:

A

Duloxetine (Cymbalta)

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59
Q

Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider:

A

With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)

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60
Q

Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to:

A

Potentiate the effects of the drug

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61
Q

Patients who are prescribed olanzapine (Zyprexa) should be monitored for:

A

insomnia

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62
Q

A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including:

A

Bradykinesia, akathisia, and agitation

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63
Q

In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is:

A

Alprazolam (Xanax)

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64
Q

Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because:

A

Zolpidem should be taken just before going to bed.

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64
Q

A patient with anxiety and depression may respond to:

A

Buspirone (Buspar) and an SSRI combined

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64
Q

When prescribing temazepam (Restoril) for insomnia, patient education includes:

A

Temazepam should not be used more than three times a week for less than 3
months.

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65
Q

One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as:

A

Drowsiness and nausea

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66
Q

Tom is taking lithium for bipolar disorder. He should be taught to:

A

Eat a diet with consistent levels of salt (sodium)

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67
Q

Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her?

A

Valproate is a known teratogen, but may be taken after the first trimester if
necessary.

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68
Q

When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include:

A

All of the above

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69
Q

Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be:

A

Ibuprofen (Advil)

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70
Q

Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be:

A

Acetaminophen with hydrocodone (Vicodin)

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71
Q

Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are:

A

Insomnia and decreased appetite

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72
Q

Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes:

A

All of the above

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73
Q

When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor:

A

Blood pressure

74
Q

Ray has been diagnosed with hypertension and an angiotensin-converting enzyme inhibitor is determined to be needed. Prior to prescribing this drug, the NP should assess for:

A

Decreased renal function

75
Q

Angiotensin-converting enzyme inhibitors are the drug of choice in treating hypertension in diabetic patients because they:

A

All of the above

76
Q

A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which of the following statements is true about this adverse response?

A

Swelling of the tongue or hoarseness are the most common symptoms.

77
Q

Angiotensin-converting enzyme inhibitors are useful in a variety of disorders. Which of the following statements are true about both its usefulness in the disorder and the reason for its use?

A

Both 1 and 2 are true but the reasons are wrong.

78
Q

Despite good blood pressure control, an NP might change a patient’s drug from an angiotensin-converting enzyme (ACE) inhibitor to an angiotensin II receptor blocker (ARB) because the ARB:

A

Does not produce a dry, hacky cough

79
Q

While taking an angiotensin II receptor blocker (ARB), patients need to avoid certain over-the-counter drugs without first consulting the provider because:

A

Both 1 and 2

80
Q

Laboratory monitoring for patients on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers should include:

A

Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL

81
Q

Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it:

A

Decreases the amount of calcium inside the cell

82
Q

Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker?

A

Edema of the hands and feet

83
Q

Patient teaching related to amlodipine includes:

A

Avoid grapefruit juice as it affects the metabolism of this drug.

84
Q

Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be:

A

Started at about half the usual dosage

85
Q

Larry has heart failure, which is being treated with digoxin because it exhibits:

A

Neither 1 nor 2

86
Q

Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for
this combination includes:

A

Serum potassium

87
Q

Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct.

A

Older adults because of reduced renal function

88
Q

Serum digoxin levels are monitored for potential toxicity. Monitoring should occur:

A

Because a reference point is needed in adjusting a dose

89
Q

Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for dyspnea, jugular venous distention, and peripheral edema because they may indicate:

A

Onset of congestive heart failure

90
Q

Which of the following is true about procainamide and its dosing schedule?

A

Doses of this drug should be taken evenly spaced around the clock to keep an even blood level

91
Q

Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following EXCEPT:

A

Take a hot shower or bath if you feel dizzy.

92
Q

The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not have thyroid disease and wants to know why the test is ordered. Which is a correct response?

A

Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism

93
Q

Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because:

A

Nitrate tolerance can develop.

94
Q

Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be:

A

Headaches are common side effects with these drugs. How severe are they?

95
Q

In teaching about the use of sublingual nitroglycerine, the patient should be instructed:

A

To place one tablet under the tongue if chest pain occurs and allow it to dissolve

96
Q

Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to:

A

Report muscle weakness or tenderness and dark urine to his provider immediately.

97
Q

Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor?

A

Increased white blood cell counts

98
Q

Because of the pattern of cholesterol synthesis, reductase inhibitors are given:

A

In the evening in a single daily dose

99
Q

Janice has elevated LDL, VLDL, and triglyceride levels. Niaspan, an extended-release form of niacin, is chosen to treat her hyperlipidemia. Due to its metabolism and excretion, which of the following laboratory results should be monitored?

A

Serum creatinine

100
Q

Niaspan is less likely to cause which side effect that is common to niacin?

A

Cutaneous flushing

101
Q

Dulcea has type 2 diabetes and a high triglyceride level. She has gemfibrozil prescribed to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug?

A

gallbladder disease

102
Q

Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct.

A

Reductase inhibitors, due to an increased risk for rhabdomyolysis

103
Q

Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other anti-lipidemics, this drug:

A

Exchanges chloride ions for negatively charged acids in the bowel

104
Q

Because of their site of action, bile acid sequestering resins:

A

Should be administered separately from other drugs by at least 4 hours

105
Q

Colestipol comes in a powdered form. The patient is taught to:

A

Mix the powder with 4 to 6 ounces of milk or fruit juice

106
Q

The choice of diuretic to use in treating hypertension is based on:

A

Level of kidney function with a thiazide diuretic being used for an estimated
glomerular filtration rate higher than the mid-40mL/min range

107
Q

Direct renin inhibitors have the following properties. They:

A

“Shut down” the entire RAAS cycle

108
Q

When comparing angiotensin-converting enzyme (ACE) and angiotensin II receptor blocker (ARB) medications, which of the following holds true?

A

Both contribute to some retention of potassium

109
Q

What does the provider understand about the issue of “Diabetic Renal Protection” with angiotensin-converting enzyme (ACE) medications? Diabetes mellitus patients:

A

Have a reduced rate of renal progression, but still need to be discontinued when advanced renal issues present

110
Q

What dermatological issue is linked to Amiodarone use?

A

Progressive change of skin tone toward a blue spectrum

111
Q

Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why?

A

Profound hypotension

112
Q

Paige has a history of chronic migraines and would benefit from preventative medication. Education regarding migraine preventive medication includes:

A

The goal of treatment is to reduce migraine occurrence by 50%.

113
Q

A first-line drug for abortive therapy in simple migraine is:

A

Naproxen (Aleve)

114
Q

Vicky, age 56 years, comes to the clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraines and states one dose usually works to abort her migraine. What is the best care for her?

A

Assess how often she is using Fiorinal and refill her medication.

115
Q

When prescribing ergotamine suppositories (Wigraine) to treat acute migraine, patient education would include:

A

They may need premedication with an antinausea medication.

116
Q

Migraines in pregnancy may be safely treated with:

A

Acetaminophen with codeine (Tylenol #3)

117
Q

Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be:

A

Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose.

118
Q

Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be:

A

Prescribe NSAIDs as abortive therapy and have her keep a headache diary to
identify her triggers.

119
Q

Jayla is a 9-year-old patient who has been diagnosed with migraines for almost 2 years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate?

A

Prescribe propranolol (Inderal) to be taken daily for at least 3 months.

120
Q

Amber is a 24-year-old patient who has had migraines for 10 years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling Amber’s naratriptan, education would include:

A

All of the above

121
Q

When prescribing for migraines, patient education includes:

A

Stress reduction and regular sleep are integral to migraine treatment.

122
Q

Juanita presents to the clinic with a complaint of headaches off and on for months. She reports they feel like someone is “squeezing” her head. She occasionally takes Tylenol for the pain, but usually just “toughs it out.” Initial treatment for tension headache includes asking her to keep a headache diary and a prescription for:

A

Naproxen (Aleve)

123
Q

Nonpharmacologic therapy for tension headaches includes:

A

All of the above

124
Q

James has been diagnosed with cluster headaches. Appropriate acute therapy would be:

A

Oxygen 100% for 15 to 30 minutes

125
Q

Preventative therapy for cluster headaches includes:

A

Ergotamine nightly before bed

126
Q

When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication-overuse headaches. A clinical characteristic of medication-overuse headaches is that they:

A

Recur when medication wears off

127
Q

Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the treatment of heart failure because they have more than one action to address the pathological changes in this disorder. Which of the following pathological changes in heart failure is NOT addressed by ACE inhibitors?

A

Activation of the sympathetic nervous system that increases heart rate and preload.

128
Q

One of the three types of heart failure involves systolic dysfunction. Potential causes of this most common form of heart failure include:

A

Myocardial ischemia and injury secondary to myocardial infarction

129
Q

The American Heart Association and the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment. Patients withsymptoms and underlying disease are classified as stage:

A

C

130
Q

Diagnosis of heart failure cannot be made by symptoms alone because many disorders share the same symptoms. The most specific and sensitive diagnostic test for heart failure is:

A

Two-dimensional echocardiograms that identify structural anomalies and cardiac
dysfunction

131
Q

Treatments for heart failure, including drug therapy, are based on the stages developed by the ACC/AHA. Stage A patients are treated with:

A

Drugs for hypertension and hyperlipidemia, if they exist

132
Q

Class I recommendations for stage A heart failure include:

A

Treatment of thyroid disorders, especially if they are associated with
tachyarrhythmias

133
Q

Stage B patients should have beta blockers added to their heart failure treatment regimen when:

A

Both 1 and 2

134
Q

Increased life expectancy for patients with heart failure has been associated with the use of:

A

ACE inhibitors, especially when started early in the disease process

135
Q

Stage C patients usually require a combination of three to four drugs to manage their heart failure. In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true?

A

Diuretics from the potassium-sparing class should be used when using an
angiotensin receptor blocker (ARB).

136
Q

Digoxin has a very limited role in treatment of heart failure. It is used mainly for patients with:

A

An audible S3

137
Q

Which of the following classes of drugs is contraindicated in heart failure?

A

Calcium channel blockers

138
Q

Heart failure is a leading cause of death and hospitalization in older adults (greater than 65 years old). The drug of choice for this population is:

A

ACE inhibitors

139
Q

ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes is considered to be safe, at least in the later parts of pregnancy?

A

Beta blockers

140
Q

Heart failure is a chronic condition that can be adequately managed in primary care. However, consultation with or referral to a cardiologist is appropriate when:

A

Any of the above

141
Q

ACE inhibitors are a foundational medication in HF. Which group of patients cannot take them safely?

A

1 and 2

142
Q

What assessment that can be done at home is the most reliable for making decisions to change HF medications?

A

weight

143
Q

Evidence is strong that the timing of HF interventions are best initiated when:

A

At the earliest indication HF patients frequently take more than one drug.

144
Q

HF patients frequently take more than one drug. When are anticoagulants typically used?

A

When there is concurrent A Fib

145
Q

What can chest x-rays contribute to the diagnosis and management of HF?

A

They provide an idea of general cardiac size and pulmonary great vessel
distribution.

146
Q

The overall goal of treating hyperlipidemia is:

A

To reduce atherogenesis

147
Q

When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment?

A

Coronary artery disease risk level

148
Q

First-line therapy for hyperlipidemia is:

A

Lifestyle changes

149
Q

James is a 45-year-old patient with an LDL level of 120 and normal triglycerides. Appropriate first-line therapy for James may include diet counseling, increased physical activity, and:

A

Sterols

150
Q

Joanne is a 60-year-old patient with an LDL of 132 and a family history of coronary artery disease. She has already tried diet changes (increased fiber and plant sterols) to lower her LDL and after 6 months her LDL is slightly higher. The next step in her treatment would be:

A

A statin

151
Q

Sharlene is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterol margarine daily for the past 3 months. Her LDL is 135 mg/dL. An appropriate treatment for her would be:

A

Determined by her risk factors

152
Q

Phil is a 54-year-old male with multiple risk factors who has been on a high-dose statin for 3 months to treat his high LDL level. His LDL is 135 mg/dL and his triglycerides are elevated. A reasonable change in therapy would be to:

A

Continue the statin and add in ezetimibe.

153
Q

Jamie is a 34-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels. What is the appropriate treatment for a pregnant woman?

A

Bile acid-binding resins

154
Q

Han is a 48-year-old diabetic with hyperlipidemia and high triglycerides. His LDL is 112 mg/dL and he has not tolerated statins. He warrants a trial of a:

A

Fibric acid derivative

155
Q

Jose is a 12-year-old overweight child with a total cholesterol of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include with a reevaluation in 6 months.

A

Sterols

156
Q

Monitoring of a patient who is on a lipid-lowering drug includes:

A

Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy, then
again in 6 weeks

157
Q

Before starting therapy with a statin, the following baseline laboratory values should be evaluated:

A

Liver function (ALT/AST) and creatine kinase

158
Q

When starting a patient on a statin, education would include:

A

All of the above

159
Q

Omega 3 fatty acids are best used to help treat:

A

High triglycerides

160
Q

When are statins traditionally ordered to be taken?

A

With the evening meal

161
Q

Which the following persons should not have a statin medication ordered?

A

Someone with 3 first- or second-degree family members with history of muscle
issues when started on statins

162
Q

Fiber supplements are great options for elderly patients who have the concurrent problem of:

A

Long-term issues of constipation

163
Q

What is considered the order of statin strength from lowest effect to highest?

A

Lovastatin, Simvastatin, Rosuvastatin

164
Q

Because primary hypertension has no identifiable cause, treatment is based on interfering with the physiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension because they:

A

Deplete body sodium and reduce fluid volume

165
Q

Because of its action on various body systems, the patient taking a thiazide or loop diuretic may also need to receive the following supplement:

A

Potassium

166
Q

All patients with hypertension benefit from diuretic therapy, but those who benefit the most are:

A

African Americans

167
Q

Beta blockers treat hypertension because they:

A

Reduce peripheral resistance

168
Q

Which of the following disease processes could be made worse by taking a nonselective beta blocker?

A

Both might worsen

169
Q

Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include:

A

Myocardial infarction

170
Q

Angiotensin-converting enzyme (ACE) inhibitors treat hypertension because they:

A

All of the above

171
Q

Compelling indications for an ACE inhibitor as treatment for hypertension based on clinical trials includes:

A

Renal parenchymal disease

172
Q

An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone?

A

Nondihydropyridine calcium channel blockers

173
Q

If not chosen as the first drug in hypertension treatment, which drug class should be added as a second step because it will enhance the effects of most other agents?

A

Diuretics

174
Q

Treatment costs are important for patients with hypertension. Which of the following statements about cost is NOT true?

A

Few antihypertensive drugs come in generic formulations.

175
Q

Caffeine, exercise, and smoking should be avoided for at least how many minutes before blood pressure measurement?

A

30

176
Q

Blood pressure checks in children:

A

Should be done during every health-care visit after 3 years of age

177
Q

Lack of adherence to blood pressure management is very common. Reasons for this lack of adherence include:

A

All of the above

178
Q

Lifestyle modifications for patients with prehypertension or hypertension include:

A

Adopt the dietary approaches to stop hypertension (DASH) diet.

179
Q

Which diuretic agents typically do not need potassium supplementation?

A

The aldosterone inhibitors

180
Q

Aldactone family medications are frequently used when the hypertensive patient also has:

A

Advancing liver dysfunction

181
Q

Hypertensive African Americans are typically listed as not being as responsive to which drug groups?

A

ACE inhibitors

182
Q

What educational points concerning fluid intake must be covered with diuretic prescriptions?

A

Fluid intake should remain near normal for optimal performance.

183
Q

What is a common side effect concern with hypertensive medications and all individuals, but especially the elderly?

A

Risk of falls

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