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Therapeutics Exam with questions and answers newest review
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Therapeutics Exam with questions and answers newest review
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Therapeutics Exam with questions andanswers newest review
Your patient complains of continued angina symptoms that interfere with activities of daily living.
NKDA. BP 147/92, HR 72
Med List: SL NTG, BB, ACE, ASA, Statin.
Which of the following would be the most appropriate change to his medication list?
Add nifedipine
Discontinue BB and add verapamil
Add ranolazine
Add isosorbide dinitrate - ANS add nifedipine
Which of the following is a monitoring parameter for heparin therapy?
aPTT
PT
INR
Anti-Xa - ANS aPTT
Which nitrate products are most appropriate for treatment of active symptoms? Prevention of
future symptoms? - ANS IV and sublingual nitroglycerin; oral isosorbides
Your patient requires chronic nitrate therapy for SIHD and is prescribed ISMN 20mg PO BID.
Develop a dosing schedule that maximizes the drug's effectiveness and preserves a min
10-hour nitrate-free interval.
What times of day should the patient take their two doses of ISMN? - ANS 8 am and 2 pm
Your patient is a 59 year old male who presents to the Emergency Room complaining of severe,
crushing chest pain with sudden onset approximately 30 minutes ago while grocery shopping.
He is also experiencing nausea, shoulder pain and some shortness of breath.
What is your first action? - ANS PPCP step: "collect"
PPCP Step 2: "Assess" Your patient is a 59 year old male who presents to the Emergency
Room complaining of severe, crushing chest pain with sudden onset approximately 30 minutes
,ago while grocery shopping. He is also experiencing nausea, shoulder pain and shortness of
breath.
His ECG is shown here. Troponin is 6.9ng/mL.
Which of the following is true?
Patient has STEMI
Patient has NSTEMI
Patient has SIHD
Need more info - ANS no idea
Your patient is a 59 year-old male who presents to the Emergency Room complaining of severe,
crushing chest pain with sudden onset approximately 30 minutes ago while grocery shopping.
He is also experiencing nausea, shoulder pain and shortness of breath.
ECG demonstrates ST segment elevation. Troponin is 6.9ng/mL.
Which of the following is the preferred reperfusion intervention in this patient?
Intravenous fibrinolytics (alteplase, etc)
Percutaneous Coronary Intervention
Medical management with optimized antithrombotic agents
DAPT - ANS PCI and alteplase second
Your patient is a 59 year-old male who presents to the Emergency Room complaining of severe,
crushing chest pain with sudden onset approximately 30 minutes ago while grocery shopping.
He is also experiencing nausea, shoulder pain and shortness of breath.
ECG demonstrates ST segment elevation. Troponin is 6.9ng/mL.
Blood oxygen levels are normal.
Which of the following should be administered to this patient in the ER?
Atorvastatin
Aspirin
Oxygen
Morphine
Metoprolol
Nitroglycerin - ANS atorvastatin - high intensity
aspirin
morphine
metoprolol - HR dependent
nitroglycerin
Your patient is a 59 year old male (85kg) who presents to the Emergency Room of your remote,
rural facility complaining of severe, crushing chest pain with sudden onset approximately 30
minutes ago. He is also experiencing nausea, shoulder pain and shortness of breath.
,His ECG demonstrates ST segment elevations and his troponin is 6.9ng/mL. SCr 0.9mg/dL. He
is complaining of 9/10 pain but his other vital signs are WNL and he has no allergies or other
relevant prior medical history.
Take 20: Use Figure 17-2 and Table 17-5 in text to develop a treatment plan for this patient.
Include drugs and monitoring parameters for both acute treatment and secondary prevention -
ANS idk
Your patient is an 85 year old female who presents with chest discomfort, shortness of breath,
and anxiety for the past 4 or 5 hours. She just "doesn't feel right" and is afraid "something very
bad will happen." She has a PMH of HTN, peptic ulcers, arthritis, and severe onychomycosis.
Current Medications: lisinopril, itraconazole, ranitidine, celecoxib
Her ECG demonstrates minimal ST depressions (<0.3mm) and she has an initial troponin level
of 1.2ng/mL. All other labs WNL.
Classify her ACS?
Calculate her TIMI Risk Score? - ANS NSTEMI
2
Your patient is an 85 year old female who is diagnosed with NSTE ACS (TIMI Score = 2). Given
her age and history of GI bleeding, her physicians consider her a "high bleed risk" patient and
wish to use an ischemia guided strategy for her ACS (no invasive procedures are planned at
this time).
Which of the following antithrombotic treatment regimens best matches the guidelines
recommendations for this patient's acute ACS care?
DAPT, IV UFH, GPI
Clopidogrel, SC enoxaparin
DAPT, SC fondaparinux
Ticagrelor, IV bivalrudin - ANS DAPT, SC enoxaparin
Your patient is genotyped as a CYP2C19*17/*17 Ultra-Rapid Metabolizer.
Which of the following statements would be true in regards to treating this patient with
clopidogrel?
A. Clopidogrel is likely to be ineffective (Very high risk of clot).
B. Clopidogrel is likely to have reduced effectiveness (High risk of clot).
C. Clopidogrel is likely to have improved efficacy (Low risk of clot).
D. Clopidogrel is more likely to result in bleeding (Very low risk of clot). - ANS C and D
Your patient is an 85 year old female who is diagnosed with NSTE ACS (TIMI Score = 2). She
has a PMH of HTN, peptic ulcers, arthritis, and severe onychomycosis.
Home Medications: lisinopril, itraconazole, ranitidine, celecoxib
, Which P2Y12 inhibitor is most appropriate for this patient?
Which of her home medications is most likely to cause harm to this patient? - ANS
clopidogrel
celecoxib
Which of the following is the primary etiology of heart failure symptoms?
Chronic Hypertension
Acute Myocardial Ischemia
Sudden Cardiac Arrhythmia
Decreased Cardiac Output - ANS decreased cardiac output
A and B initiate disease process
c is caused by HF
Which of the following is part of the biologic neurohormonal compensation for decreased CO?
Sodium retention
Vasodilation
Decreased sympathomimetic activity
Cardiac muscle atrophy - ANS sodium retention
Your patient is a 68 y/o male who presents today with orthopnea, pedal edema, and chest
discomfort on exertion. BP 168/101 mmHg. His troponin is 0.02ng/mL, BNP 4867pg/mL, and
ECG indicates LVH with NSR.
The diagnosis that best explains these signs and symptoms is:
Angina
Hypertension
Heart Failure
NSTEMI - ANS HF
Your patient is a 47 year old male with a history of HTN. His BP today is 150/92. He has an LDL
cholesterol of 169mg/dL. He smokes NMT 3 cigarettes daily and drinks alcoholic beverages
rarely. He works on an off-shore oil rig and states that he "definitely gets enough cardio" in his
daily activities. He does not complain of any symptoms of heart failure and has no
cardiomyopathy evident on diagnostic tests such as echocardogram or electrocardiogram.
Which of the following best classifies his heart failure?
NYHA Class I
NYHA Class II
ACC/AHA Stage A
ACC/AHA Stage B - ANS ACC/AHA Stage A
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