TEST BANK for Pharmacotherapy Principles and Practice
5th Edition Chisholm-Burns Test Bank. ALL 102
CHAPTERS (Complete Download). 347 Pages.
Which of the following initial antihypertensive combinations is most likely to be effective
for lowering blood pressure in SD, a Black patient with hypertension (average systolic
blood pressure 160 mm Hg; average diastolic blood pressure 96 mm Hg) based on the
results of the CREOLE study and 2017 Guideline for Prevention, Detection, Evaluation,
and Management for High Blood Pressure in Adults?
A. Lisinopril plus hydrochlorothiazide
B. Losartan plus chlorthalidone
C. Amlodipine plus benazepril
D. Amlodipine plus clonidine - C. In the CREOLE study, the combination of the calcium
channel blocker amlodipine plus the angiotensin converting-enzyme (ACE) inhibitor
perindopril or the thiazide-type diuretic hydrochlorothiazide was more effective for
reducing blood pressure than perindopril plus hydrochlorothiazide in Black patients with
uncontrolled hypertension. Some of these patients had been untreated (as is the case
for SD), and others had been receiving antihypertensive monotherapy. Therefore,
combination therapy with amlodipine plus the ACE inhibitor benazepril, or an amlodipine
with a thiazide-type diuretic, is the best choice for controlling blood pressure in this
Black patient with uncontrolled hypertension.
You are seeing a patient, BB, for his annual visit in clinic today for a blood pressure
follow up. He is a 48-year-old man with hypertension, diabetes mellitus, dyslipidemia,
and chronic kidney disease. BB also is a current smoker. His blood pressure is 128/78
mm Hg today. He reports getting the influenza vaccine last week at his local pharmacy.
Which of the following immunizations is appropriate for BB today based on
recommendations from the Centers for Disease Control and Prevention Advisory
Committee on Immunization Practices (ACIP)?
A. Human papillomavirus (HPV)
B. 23-valent pneumococcal polysaccharide vaccine(PPSV-23)
C. Zoster recombinant (RZV)
D. Hepatitis B (Hep B) - B. The 23-valent pneumococcal polysaccharide vaccine is
indicated for this 48-year-old patient because he is a smoker and has diabetes (a
chronic medical condition).
You are seeing a patient, DS, for a 3-month follow-up visit for her hypertension. She is a
46-year-old woman with hypertension, dyslipidemia, and depression. She takes
hydrochlorothiazide 25 mg orally daily, lisinopril 40 mg orally daily, and amlodipine 10
mg orally daily. DS currently has a blood pressure of 146/94 mm Hg, heart rate of 70
beats per minute, serum potassium of 4.0 mmol/L, and serum creatinine of 1.2 mg/dL.
,Which of the following oral drug therapies should be added to help DS achieve her
blood pressure goal?
A. Spironolactone 12.5 mg once daily
B. Hydralazine 10 mg three times daily
C. Diltiazem SR 120 mg once daily
D. Atenolol 25 mg once daily - A. Adding spironolactone is the best choice for DS. She
has a blood pressure goal of less than 130/80 mm Hg, and she is not currently at goal
based on the blood pressure measured today (146/94 mm Hg). She has treatment-
resistant hypertension (i.e., goal blood pressure not achieved despite receiving three
antihypertensive therapies, including a diuretic). Adding spironolactone is the most
appropriate choice based on current guidelines for treating resistant hypertension.
Which of the following was demonstrated in the Action to Control Cardiovascular Risk in
Diabetes (ACCORD) trial comparing intensive therapy with standard therapy goals in
patients with type 2 diabetes mellitus at high risk for cardiovascular (CV) events?
A. Intensive therapy significantly reduced the incidence of CV events compared with
standard therapy
B. Intensive therapy significantly increased the incidence of CV events compared with
standard therapy
C. Intensive therapy did not significantly increase the incidence of serious adverse
events compared with standard therapy
D. Intensive therapy did not significantly reduce the incidence of CV events compared
with standard therapy - D. In the ACCORD trial, intensive therapy with a systolic blood
pressure (SBP) goal of less than 120 mm Hg did not significantly reduce the incidence
of CV events compared with standard therapy with an SBP goal of less than 140 mm
Hg in patients with type 2 diabetes at high risk for CV events. The annual rate of the
primary outcome (a composite of nonfatal myocardial infarction, nonfatal stroke, or
death from cardiovascular causes) was 1.87% in the intensive-therapy group and 2.09%
in the standard-therapy group (p=0.20).
Which of the following patient populations with type 2 diabetes is a less stringent A1c
goal (e.g., 7.5-8.0%) based on current recommendations from the American Diabetes
Association (ADA) Standards of Medical Care in Diabetes?
A. Patients with newly diagnosed diabetes
B. Patients with heart failure with reduced ejection fraction and a history of myocardial
infarction
C. Patients with a life expectancy exceeding 5 years
D. Patients with a strong support system - B. A less stringent A1c goal is appropriate for
patients with type 2 diabetes, heart failure with reduced ejection fraction, and a history
of myocardial infarction. The current ADA Standards of Medical Care for Diabetes
recommends that A1c goals be individualized. Factors that should be taken into
consideration for a less stringent A1c goal for a person with type 2 diabetes include:
history of severe hypoglycemia, limited life expectancy, long-standing diabetes (e.g., 10
years), established vascular complications, extensive comorbid conditions, limited
resources/support system, and/or difficulty attaining goals despite maximal combination
therapy and counseling.
,In which of the following patient populations is a reduction in cardiovascular (CV)
morbidity and mortality most likely to occur from the use of icosapent ethyl based on the
results of the REDUCE-IT study?
A. Patients with a history of myocardial infarction (MI)
B. Patients with heart failure
C. Patients with chronic kidney disease (CKD)
D. Patients with hypertension - A. This answer is correct. The REDUCE-IT study was a
randomized, placebo-controlled study of the impact of icosapent ethyl, a highly purified
form of eicosapentaenoic acid ethyl ester, on first major atherosclerotic events (CV
death, nonfatal MI, nonfatal stroke, coronary revascularization, or unstable angina).
Patients with established CV (e.g., history of MI) or with diabetes plus other CV risk
factors were enrolled. Compared with placebo, the incidence of a first major
atherosclerotic event was significantly reduced in patients receiving icosapent ethyl.
Which of the following is the minimum frequency recommended by the American
Diabetes Association (ADA) for scanning intermittently scanned continuous glucose
monitoring (CGM) in patients receiving multiple injections of insulin daily?
A. Every 8 hours
B. Every 12 hours
C. Every 24 hours
D. When signs or symptoms of hypoglycemia are present - A. The ADA recommends
testing scanning intermittently scanned CGM values at least every 8 hours in patients
receiving multiple insulin injections.
For which of the following disease states have Healthcare Effectiveness Data and
Information Set (HEDIS) measures been established that can be used to compare the
performance of individual institutions based on national benchmarks?
A. Dyslipidemia and chronic kidney disease
B. Heart failure and peripheral artery disease
C. Obesity and stroke
D. Hypertension and diabetes - D. HEDIS measures have been established for
medication management for asthma, persistence of beta-blocker treatment after a heart
attack, controlling high blood pressure, comprehensive diabetes care, breast cancer
screening, antidepressant medication management, childhood immunization status, and
adult body mass index assessment. The controlling high blood pressure and
comprehensive diabetes care HEDIS measures can be used for comparison of
performance in caring for patients with hypertension or diabetes.
Which of the following patients is a candidate for treatment with a proprotein convertase
subtilisin/kexin type 9 (PCSK9) inhibitor based on the 2018 American College of
Cardiology (ACC)/American Heart Association (AHA) guideline on the management of
blood cholesterol to reduce atherosclerotic cardiovascular risk in adults?
A. A patient with known clinical atherosclerotic cardiovascular disease (ASCVD) on
maximally tolerated statin therapy with a 50% reduction in LDL-C and no previous use
of lipid-lowering therapies other than statins
, B. A patient with a baseline LDL-C of 160 mg/dL and no known clinical atherosclerotic
cardiovascular disease (ASCVD) who is intolerant to one statin
C. A patient with known clinical atherosclerotic cardiovascular disease (ASCVD) on
maximally tolerated statin therapy plus ezetimibe with a less than 50% reduction in LDL-
C
D. A patient with heart failure on maximally tolerated statin thera - C. This is correct.
The 2018 ACC/AHA guideline recommends the use of PCSK9 inhibitors for secondary
prevention of cardiovascular events in patients on maximally tolerated statin therapy
with clinical ASCVD who do not achieve a 50% reduction in LDL-C or who have an LDL-
C greater than 70 mg/dL. Ezetimibe is preferred over PCSK9 inhibitors in this patient
population, with a PCSK9 inhibitor added as a third agent (with a statin plus ezetimibe).
JH is a 60-year-old woman seeing you on a return visit to clinic today. She has a past
medical history of hypertension, diabetes mellitus, and chronic kidney disease (CKD).
Her albumin/creatinine ratio is 40 mg/g, and she has an estimated glomerular filtration
rate (eGFR) of 65 mL/min/1.73 m2. How would you classify this patient's eGFR and
proteinuria based on the 2012 Kidney Disease: Improving Global Outcomes (KDIGO)
guidelines and her albumin/creatinine ratio?
A. Normal eGFR and no proteinuria
B. Mildly decreased eGFR and moderately increased proteinuria
C. Mildly decreased eGFR and no proteinuria
D. Moderately decreased eGFR and moderately increased proteinuria - B. Mildly
decreased eGFR and moderately increased proteinuria is correct based on JH's eGFR
of 65 mL/min/1.73 m2 and albumin/creatinine ratio of 40 mg/g.
AZ is a 64-year-old man who presented to the hospital with non-ST-segment elevation
myocardial infarction (NSTEMI) and was taken to the cardiac catheterization laboratory.
AZ weighs 82 kg, and he is 70 inches tall. Once arterial access was obtained, he was
initiated on intravenous (IV) tirofiban. Which of the following is the most appropriate
anticoagulant therapy for AZ at this time?
A. Enoxaparin
B. Unfractionated heparin
C. Bivalirudin
D. Fondaparinux - B. Unfractionated heparin (UFH) is the best choice for AZ because in
the 2014 American College of Cardiology Foundation/American Heart Association
guideline for the management of patients with non-ST-elevation acute coronary
syndromes, UFH is recommended for patients like AZ who are receiving a glycoprotein
IIb/IIIa inhibitor (tirofiban).
AZ is a 64-year-old man who presented to the hospital with non-ST-segment elevation
myocardial infarction (NSTEMI) and was taken to the cardiac catheterization laboratory,
where a drug-eluting stent was placed in his left circumflex artery. AZ weighs 82 kg, and
he is 70 inches tall. Which of the following represents the most appropriate oral dual
antiplatelet therapy for AZ upon discharge?
A. Aspirin 81 mg daily plus clopidogrel 75 mg daily
B. Aspirin 325 mg daily plus ticagrelor 90 mg twice daily
