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FNP CARDIO LATEST UPDATE
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FNP CARDIO LATEST UPDATE FNP CARDIO LATEST UPDATE
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FNP CARDIO LATEST UPDATE 2024-2025A common lab findings with ACE Inhibitors - CORRECT ANSWER Increase K+
ACE inhibitor =
retention of potassium.
Measure potassium one month after starting and one month after changing a dose
What should you do?
Pt on Monopril and HCTZ for hypertension. His blood pressure is 160-170/92-98 on
several blood pressure checks
? Would you add an ARB? - CORRECT ANSWER If these are at maximum doses,
consideration should be given to adding a medication from a different class.
CALCIUM CHANNEL BLOCKER
NOT ARB - Adding an ARB may result in a precipitous decrease in his blood pressure
because he takes an ACE inhibitor and both of these medications work in the renin-
angiotensin-aldosterone system.
Significance of sildenafil and any blood pressure meds - CORRECT ANSWER Any
antihypertensive medication ... could have an additive effect with sildenafil (or another
medication in this
A specific drug-drug interaction to be aware of is the one that can occur with sildenafil
and alpha blockers like tamsulosin, alfuzosin, prazosin, doxazosin, or terazosin. This
combination of medications may increase the risk of symptomatic hypotension
because the effect of these two drugs is additive
- CORRECT ANSWER Consider two meds
low dose HCTZ and ARB or ace
,FNP CARDIO LATEST UPDATE 2024-2025
This patient's blood pressure goal is < 140/90 according to JNC VIII. Since he is more
than 20 points above systolic goal (or greater than 10 points above diastolic goal) it is
reasonable to consider two medications
Risk assessment for dyslipidemia- what age to start assessment - CORRECT ANSWER
Start at age 2
Dyslipidemia assessment does not necessarily mean a Dyslipidemia assessment refers
to assessing family history of dyslipidemia, premature cardiovascular disease, or
diabetes, body mass index > 85% for age and sex, or history of other systemic diseases
like Kawasaki Disease or treatment, or renal disease.
When to start lipid profiles - CORRECT ANSWER recommended between 18 and 21
years of age.
A patient taking an ACE inhibitor should avoid: - CORRECT ANSWER No K
supplements
ACE inhibitor potentially can produce hyperkalemia because its mechanism of action is
in the renin-angiotensin-aldosterone system where potassium is spared. If potassium
is taken in the form of potassium supplements, the effect will be additive and the risk
of hyperkalemia can be great.
An 80 year-old female who is otherwise well, has a blood pressure of 176/80. How
should she be managed pharmacologically? - CORRECT ANSWER CCB
This patient has isolated systolic hypertension (ISH). This is common in older adults
and is associated with tragic cardiac and cerebrovascular events. The drug class of
choice to treat these patients is a long-acting calcium channel blocker. The class of
calcium channel blockers recommended for ISH has the suffix "pine" (amlodipine,
felodipine, etc).
Remember
ISH = PINE
,FNP CARDIO LATEST UPDATE 2024-2025
ACE inhibitor is specifically indicated in patients who have ... - CORRECT ANSWER
hypertension, diabetes with proteinuria, heart failure.
77 year-old patient has had an increase in blood pressure since the last exam. The
blood pressure has risen to 168/88 with 2 readings. The last exam's reading was
144/90. If medication is to be started on this patient, what would be a good first
choice? - CORRECT ANSWER CCB
This patient is 77 years old and should have a goal blood pressure of < 150/90. A
thiazide diuretic is not a good first choice in this patient because it will not be potent
enough to decrease blood pressure by 25 points to get him to goal. A long acting
calcium channel blocker is appropriate for patients with isolated systolic hypertension
and will be more likely to get this patient to goal pressure than HCTZ. Beta-blockers
are no longer recommended first line for uncomplicated hypertension. ACE inhibitors
are very effective in patients who are high renin producers. Elderly patients tend to
produce lower amounts of renin.
A 63 year-old male has been your patient for several years. He is a former smoker who
takes simvastatin, ramipril, and an aspirin daily. His blood pressure and lipids are well
controlled. He presents to your clinic with complaints of fatigue and "just not feeling
well" for the last few days. His vital signs and exam are normal. What should be done
next?
Order a CBC and consider waiting a few days if normal.
Inquire about feelings of depression and hopelessness.
Order a CBC, metabolic panel, TSH, and urine analysis.
Order a B12 level, TSH, CBC, and chest x-ray - CORRECT ANSWER Order CBC, BMP,
TSH, u/a
Fatigue is a difficult complaint to assess and diagnose. This patient's exam and vital
signs are normal. There is no reason to think that he is infected or is bleeding, so a lone
CBC, offers little diagnostic help. However, in addition to a CBC, adding a metabolic
, FNP CARDIO LATEST UPDATE 2024-2025
panel, TSH, and urine (to screen for blood in this former smoker) is a more thorough
laboratory assessment of his fatigue.
A patient with shortness of breath has suspected heart failure. What diagnostic test
would best help determine this?
Echocardiogram
B type natriuretic peptide (BNP)
EKG
Chest x-ray - CORRECT ANSWER BNP CHEAPER
BNP is a hormone involved in regulation of blood pressure and fluid volume. When the
BNP level is 80 pg/mL or greater, the sensitivity and specificity is 98% and 92%,
favoring a diagnosis of heart failure. Alternatively, BNP levels less than 80 pg/mL
strongly suggest that heart failure is not present (Some US institutions use 100
pg/mL). Other conditions may cause elevated BNP levels: thoracic and abdominal
surgery, renal failure, and subarachnoid hemorrhage. Consequently, careful
assessment of the patient is prudent. Echocardiograms mechanically evaluate the
heart and establish an ejection fraction. If <35-40%, then HF can usually be diagnosed.
Ejection fractions do not always correlate with patient symptoms. EKG evaluates the
electrical activity of the heart. Chest x-ray can indicate heart failure but a BNP is a more
sensitive measure.
An 80 year-old patient with long standing hypertension takes Monopril and HCTZ for
hypertension. His blood pressure is 160-170/92-98 on several blood pressure checks.
What should be done about his blood pressure?
Add an angiotensin receptor blocker (ARB)
Add another diuretic
Add a calcium channel blocker
Stop the HCTZ and add a beta blocker - CORRECT ANSWER add CCB
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