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APEA 3P Exam is a comprehensive study tool designed to help students excel in their Advanced Practice Education Associ...
A 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 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 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 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 supplements 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 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 suspect ed heart failure. What diagnostic test would best help determine this? Echocardiogram B type natriuretic peptide (BNP) EKG Chest x-ray -------- Correct Answer ------- 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 stron gly 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 BNP CHEAPER
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