(latest update 2023) Regis NU641 Adv Pharmacology Quiz 1 Questions with correct Answers

Regis NU641 Adv Pharmacology hyperlipidemia - Answer- high cholesterol levels in the blood, which can lead to heart dz, stroke and other problems caused by block arteries Atherosclerosis - Answer- Changes in the walls of large arteries consisting of lipid deposits on the artery walls, which incidences can be reduced with proper treatment of hyperlipidemia Treatment goal of hyperlipidemia - Answer- lowering of the cholesterol to appropriate levels to decrease the risk of heart attack and stroke Non-pharmacology treatment - Answer- Therapeutic Lifestyle Changes (TLC) important part of treatment and are not futile Pharmacology - Answer- Medications Statins - Answer- lower cholesterol in the blood and reduce its production in the liver by blocking the enzyme that produces it; has adverse effects that can occur more frequently at higher doses. LDL cholesterol - Answer- goal of 70 in high risk patients goal of 100 in mod high-risk patients DM pts w/ acute coronary artery syndrome & multiple or uncontrolled risk factors; Tx = - Answer- TLC, changes in diet restrict refined carbs (sugar & liquid calories), wgt loss (pt will not be able to participate in aerobic activity if had previous MI), decreased insulin resistance, decreased BP, improved cardiovascular conditioning, limit/ restrict ETOH consumption. Which patients are easier to manage? - Answer- Patients at low risk for developing heart dz. What med is recommended if the LDL cannot be decreased by a high dose of potent statin? - Answer- Nicotinic acid Med combination to lower triglycerides and increase the HDL - Answer- a fibrate/nicotinic acid with statin Patient Education for Statin - Answer- Pt to report report extreme fatigue, darked-color urine, ck elevated, rhabdomylitis (muscle aches); if reported stop immediately and check LFT(Liver Fxn Test) lescol (Statin) - Answer- This med can affect liver function and increase liver enzymes as well cause the pt to feel weak, fatigue and have muscle aches checking the LFT is recommended Acute drug induced hepatitis - Answer- the Liver enzymes are elevated w/ the use of statin If pt has acute and chronic hepatitis, liver disease cirrhosis and alcoholism; or pregnant/breastfeeding mothers - Answer- DO NOT PRESCRIBE STATINS First-line therapy for hyperlipidemia - Answer- Therapeutic Life Changes (TLC) Such as: balanced diet, weight loss, minimize risk factors before medications Which drug class is most effective for the management of hyperlipidemia with concurrent elevated triglycerides (TGs)? - Answer- Fibrates How do you identify the potential serious adverse drug reactions with hyperlipidemia agents? - Answer- Monitor BP within 1 to 3 hours of administration to check for hypotensive affect What type of counseling would you give to a pt who just started on hyperlipidemia agents, such as an HMG Co-A reductase inhibitor (statin), etc? - Answer- myopathy and hepatatoxicity What is the second line treatment options if a patient fails a statin? - Answer- Bile acid-binding resins Patient factors which preclude use of an HMG Co-A reductase inhibitor - Answer- *patients with active hepatic disease or unexplained persistent elevations in aminotransferase levels * in pregnancy and during breastfeeding as cholesterol is an essential component for fetal and infant synthesis of steroids and cell membrane development *caution is necessary for patients with already increased blood glucose *levels or increased Hba1c levels. can increase the risk of statin-induced myopathy Which hyperlipidemia agents are appropriate for use in pregnancy with respect to risk to fetus as well as mother? - Answer- Fibrates Which drug (statin) decrease LDL at a greatest percentage? - Answer- Rosuvastatin Post MI dose of ASA - Answer- BMI 29 = 325mg ASA BMI 29 = 81mg ASA (low dose) heart failure (HF) - Answer- A condition in which the heart fails to discharge its contents adequately; affects the cardiovascular, musculoskeletal, renal and neuroendocrine systems systolic failure - Answer- occurs when the EF is 40% diastolic failure - Answer- HF with preserved systolic function occurs when patients are symptomatic with EFs near normal Characteristics of HF - Answer- decreased ventricular compliance and altered relaxation caused by HTN and AF Underlying Causes of Heart Failure - Answer- •Hypertension (HTN) •Diabetes •Myocardial infarction (MI) •Valvular disease •Coronary artery disease (CAD) •Congenital heart disease •Rheumatic fever •Dysrhythmias •Aging of the myocardium •Thyroid disease •Illicit drug use •Excessive alcohol use •Exposure to cardiotoxic agents •Collagen vascular disease Pathophysiology of Heart Failure •Pump failure •Cardiac remodeling •Physiologic adaptations to reduced cardiac output •Cardiac dilation •Increased sympathetic tone - •Water retention and increased blood volume •The vicious cycle of "compensatory" physiologic responses Cardiac Remodeling •Remodeling driven by neurohormonal systems •SNS sympathetic nervous system •RAAS •Ventricular dilation •Ventricular hypertrophy •Increased wall stress •Cardiac fibrosis and myocyte death •Reduction in left ventricular ejection Reduced Cardiac Output •Reduced cardiac output leads to physiologic adaptations •Cardiac dilation •Reduced contractility lowers amount of blood ejected during systole •End diastolic volume rises Heart Failure Increases Sympathetic Tonen so what med would you give? - Answer- Beta blockers The etiology of essential hypertension is - Answer- atherosclerosis BP is the combination of what two factors - Answer- CO x PVR Workup for hypertension - Answer- EKG, UA, BG, Lytes, Lipids, CRP, homecyesteine What drug can be given with thiazide diuretic to help reverse low levels of K? - Answer- spironalactone What is a common side effect of a diuretic? - Answer- hypotension Pt has HTN and DM it would be a good idea to start them on what medication? - Answer- ACE inhibitor An AA pt has HTN, on HCTZ, hx of angioedema, BP still up, what's next? - Answer- ARB & BB What is the common side effect of an ACE inhibitor? - Answer- cough Calcium Channel Blockers work by causing - Answer- vasodilation Common side effect of CCBs - Answer- constipation Alpha 2 agonists - Answer- Decrease sympathetic impulses from the CNS to the heart and arterioles, decreases HR, causing vasodilation Alpha Blockers (adrenergic agonists) - Answer- block alpha receptors causing vasodilation Are BB the first line of HTN management? - Answer- False What to prescribe a pt with a MI and a hx of asthma? - Answer- atenolol (BB) A pt on lisinopril (ACE inhibitor) is now pregnant, what should be done? - Answer- Stop immediately & start methyldopa (Alpha-2-Agonist) It is favorable to have a low HDL? - Answer- False A healthy pt has newly established hyperlipidemia, what should be prescribed? - Answer- Statin A pregnant pt just had a positive HCG & she is on atorvastatin, what should be done? - Answer- D/C and monitor or start a bile acid sequestrant Pt has triglycerides that are 500, what should be done? - Answer- Begin fibrates What are determinants of ventricular function? - Answer- Heart Rate & Stroke Volume One primary mechanism that worsens heart failure - Answer- remodeling Pt on thiazide diuretic, what lab is the most important to monitor? - Answer- Potassium (K) What lifestyle issue may be problematic with beta blocker use in men? - Answer- sexual function Pt has liver dz and hypercholesterolemia. What drug class would be safe? - Answer- bile acid sequestrants Amiodarone may be challenging to prescribed because - Answer- it has severe adverse side effects A pregnant pt has a familial hx of hypercholesterolemia, what med should she be prescribed? - Answer- colesevelam Typically, what class of medications would be the first line of treatment for HF per JNC 8 - Answer- Diuretics The meds that end with "pril" are in what class? - Answer- ACE-inhibitors ARBs should be the second line therapy after diuretics in HF? T/F - Answer- False Less frequency in dosing a medication would typically correlate to - Answer- longer half life What drug route allows for 100% bioavailability? - Answer- IV Chronic renal failure would affect which element of pharmacokinetics? - Answer- excretion